TY - JOUR
T1 - CT or Invasive Coronary Angiography in Stable Chest Pain
AU - Maurovich-Horvat, Pál
AU - Bosserdt, Maria
AU - Kofoed, Klaus F
AU - Rieckmann, Nina
AU - Benedek, Theodora
AU - Donnelly, Patrick
AU - Rodriguez-Palomares, José
AU - Erglis, Andrejs
AU - Štěchovský, Cyril
AU - Šakalyte, Gintare
AU - Čemerlić Adić, Nada
AU - Gutberlet, Matthias
AU - Dodd, Jonathan D
AU - Diez, Ignacio
AU - Davis, Gershan
AU - Zimmermann, Elke
AU - Kępka, Cezary
AU - Vidakovic, Radosav
AU - Francone, Marco
AU - Ilnicka-Suckiel, Małgorzata
AU - Plank, Fabian
AU - Knuuti, Juhani
AU - Faria, Rita
AU - Schröder, Stephen
AU - Berry, Colin
AU - Saba, Luca
AU - Ruzsics, Balazs
AU - Kubiak, Christine
AU - Gutierrez-Ibarluzea, Iñaki
AU - Schultz Hansen, Kristian
AU - Müller-Nordhorn, Jacqueline
AU - Merkely, Bela
AU - Knudsen, Andreas D
AU - Benedek, Imre
AU - Orr, Clare
AU - Xavier Valente, Filipa
AU - Zvaigzne, Ligita
AU - Suchánek, Vojtěch
AU - Zajančkauskiene, Laura
AU - Adić, Filip
AU - Woinke, Michael
AU - Hensey, Mark
AU - Lecumberri, Iñigo
AU - Thwaite, Erica
AU - Laule, Michael
AU - Kruk, Mariusz
AU - Neskovic, Aleksandar N
AU - Larsen, Linnea
AU - Jurlander, Birgit
AU - Engstrøm, Thomas
AU - DISCHARGE Trial Group
N1 - Copyright © 2022 Massachusetts Medical Society.
PY - 2022/4/28
Y1 - 2022/4/28
N2 - BACKGROUND: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain.METHODS: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris.RESULTS: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48).CONCLUSIONS: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
AB - BACKGROUND: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain.METHODS: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris.RESULTS: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48).CONCLUSIONS: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
KW - Angina Pectoris/diagnostic imaging
KW - Chest Pain/diagnostic imaging
KW - Coronary Angiography/adverse effects
KW - Coronary Artery Disease/complications
KW - Female
KW - Humans
KW - Male
KW - Tomography, X-Ray Computed/adverse effects
UR - http://www.scopus.com/inward/record.url?scp=85126431437&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa2200963
DO - 10.1056/NEJMoa2200963
M3 - Journal article
C2 - 35240010
SN - 0028-4793
VL - 386
SP - 1591
EP - 1602
JO - The New England journal of medicine
JF - The New England journal of medicine
IS - 17
ER -