CT or Invasive Coronary Angiography in Stable Chest Pain

Pál Maurovich-Horvat; Maria Bosserdt; Klaus F Kofoed; Nina Rieckmann; Theodora Benedek; Patrick Donnelly; José Rodriguez-Palomares; Andrejs Erglis; Cyril Štěchovský; Gintare Šakalyte; Nada Čemerlić Adić; Matthias Gutberlet; Jonathan D Dodd; Ignacio Diez; Gershan Davis; Elke Zimmermann; Cezary Kępka; Radosav Vidakovic; Marco Francone; Małgorzata Ilnicka-Suckiel; Fabian Plank; Juhani Knuuti; Rita Faria; Stephen Schröder; Colin Berry; Luca Saba; Balazs Ruzsics; Christine Kubiak; Iñaki Gutierrez-Ibarluzea; Kristian Schultz Hansen; Jacqueline Müller-Nordhorn; Bela Merkely; Andreas D Knudsen; Imre Benedek; Clare Orr; Filipa Xavier Valente; Ligita Zvaigzne; Vojtěch Suchánek; Laura Zajančkauskiene; Filip Adić; Michael Woinke; Mark Hensey; Iñigo Lecumberri; Erica Thwaite; Michael Laule; Mariusz Kruk; Aleksandar N Neskovic; Massimo Mancone; Donata Kuśmierz; Gudrun Feuchtner; DISCHARGE Trial Group

doi:10.1056/NEJMoa2200963

CT or Invasive Coronary Angiography in Stable Chest Pain

Pál Maurovich-Horvat
, Maria Bosserdt
, Klaus F Kofoed
, Nina Rieckmann
, Theodora Benedek
, Patrick Donnelly
, José Rodriguez-Palomares
, Andrejs Erglis
, Cyril Štěchovský
, Gintare Šakalyte
, Nada Čemerlić Adić
, Matthias Gutberlet
, Jonathan D Dodd
, Ignacio Diez
, Gershan Davis
, Elke Zimmermann
, Cezary Kępka
, Radosav Vidakovic
, Marco Francone
, Małgorzata Ilnicka-Suckiel

Fabian Plank, Juhani Knuuti, Rita Faria, Stephen Schröder, Colin Berry, Luca Saba, Balazs Ruzsics, Christine Kubiak, Iñaki Gutierrez-Ibarluzea, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Andreas D Knudsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Vojtěch Suchánek, Laura Zajančkauskiene, Filip Adić, Michael Woinke, Mark Hensey, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Aleksandar N Neskovic, Massimo Mancone, Donata Kuśmierz, Gudrun Feuchtner, DISCHARGE Trial Group

Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
The authors' affiliations are as follows: the Heart and Vascular Center (P.M.-H., B.M., B.S., Z.D.D., M. Boussoussou) and the Department of Radiology, Medical Imaging Center (P.M.-H.), Semmelweis University, Budapest, Hungary; the Departments of Radiology (M. Bosserdt, E.Z., A.E.N., R. Haase, S.F., M. Rief, V.W., M.E., M.D.) and Cardiology and Angiology (M.L., H.D.), the Institute of Public Health (N.R., J.M.-N.), and the Institute of Biometry and Clinical Epidemiology (K.N.), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin and DZHK (German Center for Cardiovascular Research) Partner Site Berlin (H.D., M.D.), Berlin Institute of Health and Berlin University Alliance (M.D.), Berlin, the Departments of Radiology (M.G.) and Cardiology (M.W.), University of Leipzig Heart Center, Leipzig, the Department of Cardiology, Alb Fils Kliniken, Göppingen (S.S., T.D.), the Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Munich (J.M.-N.), and the Departmen

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

Abstract

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.).

Originalsprog	Engelsk
Tidsskrift	New England Journal of Medicine
Vol/bind	386
Udgave nummer	17
Sider (fra-til)	1591-1602
Antal sider	12
ISSN	0028-4793
DOI	https://doi.org/10.1056/NEJMoa2200963
Status	Udgivet - 28 apr. 2022
Udgivet eksternt	Ja

Adgang til dokumentet

10.1056/NEJMoa2200963

Citationsformater

Maurovich-Horvat, P., Bosserdt, M., Kofoed, K. F., Rieckmann, N., Benedek, T., Donnelly, P., Rodriguez-Palomares, J., Erglis, A., Štěchovský, C., Šakalyte, G., Čemerlić Adić, N., Gutberlet, M., Dodd, J. D., Diez, I., Davis, G., Zimmermann, E., Kępka, C., Vidakovic, R., Francone, M., ... DISCHARGE Trial Group (2022). CT or Invasive Coronary Angiography in Stable Chest Pain. New England Journal of Medicine, 386(17), 1591-1602. https://doi.org/10.1056/NEJMoa2200963

@article{248cce6dad764c75bbadccd17eefc7f7,

title = "CT or Invasive Coronary Angiography in Stable Chest Pain",

abstract = "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.).",

keywords = "Angina Pectoris, Chest Pain, Coronary Angiography, Coronary Artery Disease, Female, Humans, Male, Tomography, X-Ray Computed, Journal Article, Multicenter Study, Pragmatic Clinical Trial, Randomized Controlled Trial",

author = "P{\'a}l Maurovich-Horvat and Maria Bosserdt and Kofoed, \{Klaus F\} and Nina Rieckmann and Theodora Benedek and Patrick Donnelly and Jos{\'e} Rodriguez-Palomares and Andrejs Erglis and Cyril {\v S}t{\v e}chovsk{\'y} and Gintare {\v S}akalyte and \{{\v C}emerli{\'c} Adi{\'c}\}, Nada and Matthias Gutberlet and Dodd, \{Jonathan D\} and Ignacio Diez and Gershan Davis and Elke Zimmermann and Cezary K{\c e}pka and Radosav Vidakovic and Marco Francone and Ma{\l}gorzata 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 I{\~n}aki Gutierrez-Ibarluzea and \{Schultz Hansen\}, Kristian and Jacqueline M{\"u}ller-Nordhorn and Bela Merkely and Knudsen, \{Andreas D\} and Imre Benedek and Clare Orr and \{Xavier Valente\}, Filipa and Ligita Zvaigzne and Vojt{\v e}ch Such{\'a}nek and Laura Zajan{\v c}kauskiene and Filip Adi{\'c} and Michael Woinke and Mark Hensey and I{\~n}igo Lecumberri and Erica Thwaite and Michael Laule and Mariusz Kruk and Neskovic, \{Aleksandar N\} and Massimo Mancone and Donata Ku{\'s}mierz and Gudrun Feuchtner and \{DISCHARGE Trial Group\}",

note = "Copyright {\textcopyright} 2022 Massachusetts Medical Society.",

year = "2022",

month = apr,

day = "28",

doi = "10.1056/NEJMoa2200963",

language = "English",

volume = "386",

pages = "1591--1602",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "17",

}

Maurovich-Horvat, P, Bosserdt, M, Kofoed, KF, Rieckmann, N, Benedek, T, Donnelly, P, Rodriguez-Palomares, J, Erglis, A, Štěchovský, C, Šakalyte, G, Čemerlić Adić, N, Gutberlet, M, Dodd, JD, Diez, I, Davis, G, Zimmermann, E, Kępka, C, Vidakovic, R, Francone, M, Ilnicka-Suckiel, M, Plank, F, Knuuti, J, Faria, R, Schröder, S, Berry, C, Saba, L, Ruzsics, B, Kubiak, C, Gutierrez-Ibarluzea, I, Schultz Hansen, K, Müller-Nordhorn, J, Merkely, B, Knudsen, AD, Benedek, I, Orr, C, Xavier Valente, F, Zvaigzne, L, Suchánek, V, Zajančkauskiene, L, Adić, F, Woinke, M, Hensey, M, Lecumberri, I, Thwaite, E, Laule, M, Kruk, M, Neskovic, AN, Mancone, M, Kuśmierz, D, Feuchtner, G & DISCHARGE Trial Group 2022, 'CT or Invasive Coronary Angiography in Stable Chest Pain', New England Journal of Medicine, bind 386, nr. 17, s. 1591-1602. https://doi.org/10.1056/NEJMoa2200963

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 - Mancone, Massimo

AU - Kuśmierz, Donata

AU - Feuchtner, Gudrun

AU - DISCHARGE Trial Group

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

KW - Chest Pain

KW - Coronary Angiography

KW - Coronary Artery Disease

KW - Female

KW - Humans

KW - Male

KW - Tomography, X-Ray Computed

KW - Journal Article

KW - Multicenter Study

KW - Pragmatic Clinical Trial

KW - Randomized Controlled Trial

U2 - 10.1056/NEJMoa2200963

DO - 10.1056/NEJMoa2200963

M3 - Journal article

C2 - 35240010

SN - 0028-4793

VL - 386

SP - 1591

EP - 1602

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 17

ER -

CT or Invasive Coronary Angiography in Stable Chest Pain

Abstract

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