Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

Nina Rieckmann; Konrad Neumann; Pál Maurovich-Horvat; Klaus F Kofoed; Theodora Benedek; Maria Bosserdt; Patrick Donnelly; José Rodriguez-Palomares; Andrejs Erglis; Cyril Štechovský; Gintare Šakalyte; Nada Cemerlic Adic; Matthias Gutberlet; Ignacio Diez; Gershan Davis; Elke Zimmermann; Cezary Kepka; Radosav Vidakovic; Marco Francone; Malgorzata Ilnicka-Suckiel; Fabian Plank; Juhani Knuuti; Rita Faria; Stephen Schröder; Colin Berry; Luca Saba; Balazs Ruzsics; Christine Kubiak; Kristian Schultz Hansen; Jacqueline Müller-Nordhorn; Bela Merkely; Andreas D Knudsen; Imre Benedek; Clare Orr; Filipa Xavier Valente; Ligita Zvaigzne; Vojtech Suchánek; Laura Zajanckauskiene; Filip Adic; Michael Woinke; Darragh Waters; Iñigo Lecumberri; Erica Thwaite; Michael Laule; Mariusz Kruk; Aleksandar N Neskovic; Lucia Ilaria Birtolo; Linnea Larsen; Birgit Jurlander; Thomas Engstrøm; DISCHARGE Trial Group

doi:10.1001/jamacardio.2025.0992

Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

Nina Rieckmann, Konrad Neumann, Pál Maurovich-Horvat, Klaus F Kofoed, Theodora Benedek, Maria Bosserdt, Patrick Donnelly, José Rodriguez-Palomares, Andrejs Erglis, Cyril Štechovský, Gintare Šakalyte, Nada Cemerlic Adic, Matthias Gutberlet, Ignacio Diez, Gershan Davis, Elke Zimmermann, Cezary Kepka, Radosav Vidakovic, Marco Francone, Malgorzata Ilnicka-SuckielFabian Plank, Juhani Knuuti, Rita Faria, Stephen Schröder, Colin Berry, Luca Saba, Balazs Ruzsics, Christine Kubiak, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Andreas D Knudsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Vojtech Suchánek, Laura Zajanckauskiene, Filip Adic, Michael Woinke, Darragh Waters, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Aleksandar N Neskovic, Lucia Ilaria Birtolo, Linnea Larsen, Birgit Jurlander, Thomas Engstrøm, DISCHARGE Trial Group

Abstract

IMPORTANCE: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.

OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.

DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.

INTERVENTIONS: Random assignment to CT or ICA.

MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.

RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).

CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.

Originalsprog	Engelsk
Tidsskrift	JAMA Cardiology
Vol/bind	10
Udgave nummer	7
Sider (fra-til)	728-739
Antal sider	12
ISSN	2380-6583
DOI	https://doi.org/10.1001/jamacardio.2025.0992
Status	Udgivet - 1 jul. 2025

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Rieckmann, N., Neumann, K., Maurovich-Horvat, P., Kofoed, K. F., Benedek, T., Bosserdt, M., Donnelly, P., Rodriguez-Palomares, J., Erglis, A., Štechovský, C., Šakalyte, G., Adic, N. C., Gutberlet, M., Diez, I., Davis, G., Zimmermann, E., Kepka, C., Vidakovic, R., Francone, M., ... DISCHARGE Trial Group (2025). Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial. JAMA Cardiology, 10(7), 728-739. https://doi.org/10.1001/jamacardio.2025.0992

Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial. / Rieckmann, Nina; Neumann, Konrad; Maurovich-Horvat, Pál et al.
I: JAMA Cardiology, Bind 10, Nr. 7, 01.07.2025, s. 728-739.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Rieckmann, N, Neumann, K, Maurovich-Horvat, P, Kofoed, KF, Benedek, T, Bosserdt, M, Donnelly, P, Rodriguez-Palomares, J, Erglis, A, Štechovský, C, Šakalyte, G, Adic, NC, Gutberlet, M, Diez, I, Davis, G, Zimmermann, E, Kepka, C, Vidakovic, R, Francone, M, Ilnicka-Suckiel, M, Plank, F, Knuuti, J, Faria, R, Schröder, S, Berry, C, Saba, L, Ruzsics, B, Kubiak, C, Hansen, KS, Müller-Nordhorn, J, Merkely, B, Knudsen, AD, Benedek, I, Orr, C, Valente, FX, Zvaigzne, L, Suchánek, V, Zajanckauskiene, L, Adic, F, Woinke, M, Waters, D, Lecumberri, I, Thwaite, E, Laule, M, Kruk, M, Neskovic, AN, Birtolo, LI, Larsen, L, Jurlander, B, Engstrøm, T & DISCHARGE Trial Group 2025, 'Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial', JAMA Cardiology, bind 10, nr. 7, s. 728-739. https://doi.org/10.1001/jamacardio.2025.0992

@article{467d68a092514d7c8c71228da22139cf,

title = "Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial",

abstract = "IMPORTANCE: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.INTERVENTIONS: Random assignment to CT or ICA.MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2\%]), 1735 (96.0\%) in the CT group and 1671 (95.3\%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95\% CI, 3.1-4.9; P < .001; ICA = 4.6; 95\% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95\% CI, -0.4 to 0; P = .04; ICA = -0.2; 95\% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95\% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95\% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95\% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2\% vs 6.2\%; P = .007).CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.",

keywords = "Humans, Female, Male, Coronary Angiography/methods, Quality of Life, Middle Aged, Health Status, Tomography, X-Ray Computed/methods, Chest Pain/diagnostic imaging, Aged, Coronary Artery Disease/diagnostic imaging",

author = "Nina Rieckmann and Konrad Neumann and P{\'a}l Maurovich-Horvat and Kofoed, \{Klaus F\} and Theodora Benedek and Maria Bosserdt and Patrick Donnelly and Jos{\'e} Rodriguez-Palomares and Andrejs Erglis and Cyril {\v S}techovsk{\'y} and Gintare {\v S}akalyte and Adic, \{Nada Cemerlic\} and Matthias Gutberlet and Ignacio Diez and Gershan Davis and Elke Zimmermann and Cezary Kepka and Radosav Vidakovic and Marco Francone and Malgorzata Ilnicka-Suckiel and Fabian Plank and Juhani Knuuti and Rita Faria and Stephen Schr{\"o}der and Colin Berry and Luca Saba and Balazs Ruzsics and Christine Kubiak and Hansen, \{Kristian Schultz\} and Jacqueline M{\"u}ller-Nordhorn and Bela Merkely and Knudsen, \{Andreas D\} and Imre Benedek and Clare Orr and Valente, \{Filipa Xavier\} and Ligita Zvaigzne and Vojtech Such{\'a}nek and Laura Zajanckauskiene and Filip Adic and Michael Woinke and Darragh Waters and I{\~n}igo Lecumberri and Erica Thwaite and Michael Laule and Mariusz Kruk and Neskovic, \{Aleksandar N\} and Birtolo, \{Lucia Ilaria\} and Linnea Larsen and Birgit Jurlander and Thomas Engstr{\o}m and \{DISCHARGE Trial Group\}",

year = "2025",

month = jul,

day = "1",

doi = "10.1001/jamacardio.2025.0992",

language = "English",

volume = "10",

pages = "728--739",

journal = "JAMA Cardiology",

issn = "2380-6583",

publisher = "American Medical Association",

number = "7",

}

TY - JOUR

T1 - Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain

T2 - A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

AU - Rieckmann, Nina

AU - Neumann, Konrad

AU - Maurovich-Horvat, Pál

AU - Kofoed, Klaus F

AU - Benedek, Theodora

AU - Bosserdt, Maria

AU - Donnelly, Patrick

AU - Rodriguez-Palomares, José

AU - Erglis, Andrejs

AU - Štechovský, Cyril

AU - Šakalyte, Gintare

AU - Adic, Nada Cemerlic

AU - Gutberlet, Matthias

AU - Diez, Ignacio

AU - Davis, Gershan

AU - Zimmermann, Elke

AU - Kepka, Cezary

AU - Vidakovic, Radosav

AU - Francone, Marco

AU - Ilnicka-Suckiel, Malgorzata

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 - Hansen, Kristian Schultz

AU - Müller-Nordhorn, Jacqueline

AU - Merkely, Bela

AU - Knudsen, Andreas D

AU - Benedek, Imre

AU - Orr, Clare

AU - Valente, Filipa Xavier

AU - Zvaigzne, Ligita

AU - Suchánek, Vojtech

AU - Zajanckauskiene, Laura

AU - Adic, Filip

AU - Woinke, Michael

AU - Waters, Darragh

AU - Lecumberri, Iñigo

AU - Thwaite, Erica

AU - Laule, Michael

AU - Kruk, Mariusz

AU - Neskovic, Aleksandar N

AU - Birtolo, Lucia Ilaria

AU - Larsen, Linnea

AU - Jurlander, Birgit

AU - Engstrøm, Thomas

AU - DISCHARGE Trial Group

PY - 2025/7/1

Y1 - 2025/7/1

N2 - IMPORTANCE: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.INTERVENTIONS: Random assignment to CT or ICA.MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.

AB - IMPORTANCE: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.INTERVENTIONS: Random assignment to CT or ICA.MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.

KW - Humans

KW - Female

KW - Male

KW - Coronary Angiography/methods

KW - Quality of Life

KW - Middle Aged

KW - Health Status

KW - Tomography, X-Ray Computed/methods

KW - Chest Pain/diagnostic imaging

KW - Aged

KW - Coronary Artery Disease/diagnostic imaging

UR - https://www.scopus.com/pages/publications/105005542641

U2 - 10.1001/jamacardio.2025.0992

DO - 10.1001/jamacardio.2025.0992

M3 - Journal article

C2 - 40366703

SN - 2380-6583

VL - 10

SP - 728

EP - 739

JO - JAMA Cardiology

JF - JAMA Cardiology

IS - 7

ER -

Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

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