Background
In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate and non-invasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the treatment of CAD in reducing the frequency of major adverse cardiovascular events is uncertain.
Methods
We conducted a pragmatic randomized trial comparing CT with ICA as initial imaging strategies to guide the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA in one of the 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.
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 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; confidence interval [95% CI], 0.46 to 1.07; P =0.10).
Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI). 0.13 to 0.55).
Angina during the last 4 weeks of follow-up was reported in 8.8% of patients in the CT group and 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92). to 1.48).
Conclusions
- Among patients referred for invasive coronary angiography (ICA) due to stable chest pain and intermediate probability of CAD before the test, 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 Seventh Framework Program of the European Union and others; DISCHARGE ClinicalTrials.gov, NCT02400229).
