Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease - DISCHARGE

Mar 12, 2024
Font Size
A
A
A
Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC; Kim A. Eagle, MD, MACC
Trial Sponsor:
European Union Seventh Framework Program and others.
Date Published:
02/28/2024
Date Updated:
03/12/2024
Original Posted Date:
03/07/2022
References

Contribution To Literature:

Highlighted text has been updated as of March 12, 2024.

The DISCHARGE trial showed that CT was similar to invasive coronary angiography at preventing major adverse cardiovascular events among patients with stable chest pain.

Description:

The goal of the trial was to evaluate computed tomography (CT) compared with invasive coronary angiography among patients with stable chest pain and intermediate pretest probability of obstructive coronary artery disease.

Study Design

  • Randomization
  • Parallel

Patients with stable chest pain were randomized to CT (n = 1,808) vs. invasive coronary angiography (n = 1,753).

  • Total number of enrollees: 3,561
  • Duration of follow-up: 3.5 years
  • Median patient age: 61 years
  • Percentage female: 56%
  • Percentage with diabetes: 16%

Inclusion criteria:

  • At least 30 years of age
  • Stable chest pain
  • Intermediate pretest probability of obstructive coronary artery disease

Exclusion criteria:

  • Receipt of hemodialysis
  • Absence of sinus rhythm

Principal Findings:

The primary outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke occurred in 2.1% of the CT group compared with 3.0% of the invasive coronary angiography group (p = 0.1).

Secondary outcomes:

  • Major procedure-related complications: 0.5% of the CT group vs. 1.9% of the invasive coronary angiography group
  • Angina during the final 4 weeks of follow-up: 8.8% of the CT group vs. 7.5% of the invasive coronary angiography group

Outcomes according to age:

  • Age did not modify the association between CT vs. invasive coronary angiography on MACE (p for interaction = 0.31).
  • Age modified the association between CT vs. invasive coronary angiography on procedure-related complications (p for interaction = 0.005). Procedure-related complications were higher in older individuals.

Interpretation:

Among patients with stable chest pain and intermediate risk of obstructive coronary artery disease, CT was similar to invasive coronary angiography at preventing major adverse cardiovascular events. The frequency of major procedure-related complications was lower in the CT group, especially among younger individuals.

References:

The DISCHARGE Trial Group. Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial. JAMA Cardiol 2024;Feb 28:[Epublished].

The DISCHARGE Trial Group. CT or Invasive Coronary Angiography in Stable Chest Pain. N Engl J Med 2022;386:1591-1602.

Editorial: Loscalzo J. Evaluating Stable Chest Pain — An Evolving Approach. N Engl J Med 2022;386:1659-60.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Chest Pain, Coronary Angiography, Tomography, X-Ray Computed


< Back to Listings