CT or invasive coronary angiography in stable chest pain

Maurovich-Horvat, P. et al. (2022) CT or invasive coronary angiography in stable chest pain. New England Journal of Medicine, 386(17), pp. 1591-1602. (doi: 10.1056/NEJMoa2200963) (PMID:35240010)

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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.

Item Type:Articles
Additional Information:Supported by a grant (EC-GA 603266) from the European Union Seventh Framework Program, a Digital Health Accelerator grant from the Berlin Institute of Health, a grant from Rigshospitalet of the University of Copenhagen, a Centre of Research Excellence grant (RE/18/6/34217) from the British Heart Foundation, and Radiomics Priority Program grants (DE 1361/19-1 [428222922] and 20-1 [428223139] in SPP2177/1) and a grant (GRK 2260/1 [289347353])for the graduate research training group Biophysical Quantitative Imaging toward Clinical Diagnosis (BIOQIC) from the German Research Foundation
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Delles, Professor Christian
Authors: 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., 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, A. D., 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, A. N., Mancone, M., Kuśmierz, D., Feuchtner, G., Pietilä, M., Gama Ribeiro, V., Drosch, T., Delles, C., Matta, G., Fisher, M., Szilveszter, B., Larsen, L., Ratiu, M., Kelly, S., Garcia del Blanco, B., Rubio, A., Drobni, Z. D., Jurlander, B., Rodean, I., Regan, S., Cuéllar Calabria, H., Boussoussou, M., Engstrøm, T., Hodas, R., Napp, A. E., Haase, R., Feger, S., Serna-Higuita, L. M., Neumann, K., Dreger, H., Rief, M., Wieske, V., Estrella, M., Martus, P., and Dewey, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:New England Journal of Medicine
Publisher:Massachusetts Medical Society
ISSN (Online):1533-4406
Published Online:04 March 2022
Copyright Holders:Copyright © 2022 Massachusetts Medical Society
First Published:First published in New England Journal of Medicine 386(17): 1591-1602
Publisher Policy:Reproduced in accordance with the publisher copyright policy
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceColin BerryBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science