BACKGROUND AND PURPOSE:

• Computed tomography (CT) is a non-invasive alternative to invasive coronary angiography (ICA) for diagnosing obstructive coronary artery disease (CAD)
• The DISCHARGE trial group (NEJM, 2022) examined the effectiveness of CT and ICA in preventing major adverse cardiovascular events

METHODS:

• Pragmatic, randomized trial
  • Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial
• Participants
  • Stable chest pain
  • Intermediate pretest probability of obstructive CAD
  • Referred for ICA
• Interventions
  • CT as initial diagnostic imaging strategy
  • ICA as initial diagnostic imaging strategy
• Primary outcome
  • Major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years
• Secondary outcomes
  • Procedure-related complications
  • Angina pectoris

RESULTS:

• CT group: 1808 patients | ICA group: 1753 patients
  • 56.2% women
• There was no significant difference in the incidence of major adverse cardiovascular events between the two groups
  • CT: 2.1%
  • ICA: 3.0%
  • Hazard ratio (HR) 0.70 (95% CI, 0.46 to 1.07); P=0.10
• There was a reduced incidence of major procedure-related complications in the CT group
  • CT: 0.5%
  • ICA: 1.9%
  • HR 0.26 (95% CI, 0.13 to 0.55)
• There was no difference in the rates of angina reported during the final 4 weeks of follow-up
  • CT: 8.8%
  • ICA: 7.5%
  • OR 1.17 (95% CI, 0.92 to 1.48)

CONCLUSION:

• Patients referred for chest pain and suspected CAD experienced similar levels of major adverse cardiovascular events, regardless of whether their initial diagnostic strategy included CT or ICA
• There were fewer procedure-related complications with CT
• The authors state

The CT strategy was associated with fewer major complications and revascularization procedures, and there were no substantial differences in the incidence of angina in the two groups at follow-up

Learn More – Primary Sources:

CT or Invasive Coronary Angiography in Stable Chest Pain

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