TY - JOUR

T1 - CT or Invasive Coronary Angiography in Stable Chest Pain

AU - Maurovich-Horvat, Pal

AU - Bosserdt, Maria

AU - Kofoed, Klaus F.

AU - Rieckmann, Nina

AU - Benedek, Theodora

AU - Donnelly, Patrick

AU - Rodriguez-Palomares, Jose

AU - Erglis, Andrejs

AU - Stechovsk, Cyril

AU - Sakalyte, Gintare

AU - Adic, Nada Cemerlic

AU - Gutberlet, Matthias

AU - Dodd, Jonathan D.

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 - Schroder, Stephen

AU - Berry, Colin

AU - Saba, Luca

AU - Ruzsics, Balazs

AU - Kubiak, Christine

AU - Gutierrez-Ibarluzea, Inaki

AU - Hansen, Kristian Schultz

AU - Muller-Nordhorn, Jacqueline

AU - Merkely, Bela

AU - Knudsen, Andreas D.

AU - Benedek, Imre

AU - Orr, Clare

AU - Valente, Filipa Xavier

AU - Zvaigzne, Ligita

AU - Suchanek, Vojtech

AU - Zajanckauskiene, Laura

AU - Adic, Flip

AU - Woinke, Michael

AU - Hensey, Mark

AU - Lecumberri, Inigo

AU - Thwaite, Erica

AU - Laule, Michael

AU - Kruk, Mariusz

AU - Neskovic, Aleksandar N.

AU - Larsen, Linnea

AU - Jurlander, Birgit

AU - Engstrom, Thomas

AU - DISCHARGE Trial Grp

PY - 2022

Y1 - 2022

N2 - BACKGROUNDIn 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.METHODSWe 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.RESULTSAmong 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).CONCLUSIONSAmong 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.

AB - BACKGROUNDIn 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.METHODSWe 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.RESULTSAmong 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).CONCLUSIONSAmong 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.

KW - GUIDELINES

KW - MANAGEMENT

KW - ANGINA

KW - PCI

U2 - 10.1056/NEJMoa2200963

DO - 10.1056/NEJMoa2200963

M3 - Journal article

C2 - 35240010

VL - 386

SP - 1591

EP - 1602

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

ER -