Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial

Napp, A. E. et al. (2016) Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial. European Radiology, 27(7), pp. 2957-2968. (doi:10.1007/s00330-016-4620-z) (PMID:27864607)

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Abstract

Objectives: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). Methods: In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Results: Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. Conclusions: The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. Key Points: • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Roditi, Dr Giles
Authors: Napp, A. E., Haase, R., Laule, M., Schuetz, G. M., Rief, M., Dreger, H., Feuchtner, G., Friedrich, G., Špaček, M., Suchánek, V., Fuglsang Kofoed, K., Engstroem, T., Schroeder, S., Drosch, T., Gutberlet, M., Woinke, M., Maurovich-Horvat, P., Merkely, B., Donnelly, P., Ball, P., Dodd, J. D., Quinn, M., Saba, L., Porcu, M., Francone, M., Mancone, M., Erglis, A., Zvaigzne, L., Jankauskas, A., Sakalyte, G., Harań, T., Ilnicka-Suckiel, M., Bettencourt, N., Gama-Ribeiro, V., Condrea, S., Benedek, I., Čemerlić Adjić, N., Adjić, O., Rodriguez-Palomares, J., Garcia Del Blanco, B., Roditi, G., Berry, C., Davis, G., Thwaite, E., Knuuti, J., Pietilä, M., Kępka, C., Kruk, M., Vidakovic, R., Neskovic, A. N., Díez, I., Lecumberri, I., Geleijns, J., Kubiak, C., Strenge-Hesse, A., Do, T.-H., Frömel, F., Gutiérrez-Ibarluzea, I., Benguria-Arrate, G., Keiding, H., Katzer, C., Müller-Nordhorn, J., Rieckmann, N., Walther, M., Schlattmann, P., and Dewey, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:European Radiology
Publisher:Springer
ISSN:0938-7994
ISSN (Online):1432-1084
Published Online:18 November 2016

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
621371DISCHARGEChristian DellesEuropean Commission (EC)603266RI CARDIOVASCULAR & MEDICAL SCIENCES