SMART-EXAM Trial Comparing Routine Versus As-Needed Stress Testing in Asymptomatic Patients With High-Risk Coronary Calcium

What this Trial Is About

This research aims to compare the effects of routine stress testing versus stress testing only when needed in adults who have high-risk coronary calcium deposits but no symptoms or diagnosed atherosclerotic cardiovascular disease (ASCVD). The study focuses on people with an Agatston Score of 400 or higher, which indicates significant coronary artery calcium. Coronary artery calcium scanning is used to detect early signs of coronary artery disease and has been linked to future heart problems and death, regardless of traditional risk factors. Guidelines currently recommend calcium scoring only for certain risk groups, but it is increasingly used by the general public for self-assessment. Participants will be assigned to either receive routine non-invasive stress tests—including nuclear imaging, stress echocardiography, exercise electrocardiography, or stress cardiac MRI—or to receive optimal medical treatment without further testing. The purpose is to assess whether routine stress testing can better prevent major adverse cardiovascular events compared to testing as needed. The study includes a median follow-up period of up to 4.5 years to monitor outcomes. During the study, researchers will track the occurrence of major adverse cardiovascular events over the follow-up period. Participants will receive medical evaluations and monitoring based on their assigned group. The study will measure how often serious heart problems occur in both groups, aiming to understand the best approach for managing asymptomatic patients with high coronary calcium scores. The total participation time varies with the median follow-up of 4.5 years to observe long-term effects.

Routine Versus As-Needed Stress Testing in Asymptomatic Patients With High-Risk Coronary Calcium