Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial
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Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial. / Mancone, Massimo; Mézquita, Aldo J Vázquez; Birtolo, Lucia Ilaria; Maurovich-Horvat, Pal; Kofoed, Klaus F; Benedek, Theodora; Donnelly, Patrick; Rodriguez-Palomares, Jose; Erglis, Andrejs; Štěchovský, Cyril; Šakalytė, Gintare; Ađić, Nada Čemerlić; Gutberlet, Matthias; Diez, Ignacio; Davis, Gershan; Zimmermann, Elke; Kępka, Cezary; Vidakovic, Radosav; Francone, Marco; Ilnicka-Suckiel, Małgorzata; Plank, Fabian; Knuuti, Juhanni; Faria, Rita; Schröder, Stephen; Berry, Colin; Saba, Luca; Ruzsics, Balazs; Rieckmann, Nina; Kubiak, Christine; Hansen, Kristian Schultz; Müller-Nordhorn, Jaqueline; Merkely, Bela; Sigvardsen, Per E; Benedek, Imre; Orr, Clare; Valente, Filipa Xavier; Zvaigzne, Ligita; Suchánek, Vojtěch; Jankauskas, Antanas; Ađić, Filip; Woinke, Michael; Keane, Stephen; Lecumberri, Ignacio; Thwaite, Erica; Kruk, Mariusz; Jovanovic, Vladimir; Kuśmierz, Donata; Feuchtner, Gudren; Pietilä, Mikko; Ribeiro, Vasco Gama; Drosch, Tanja; Delles, Christian; Palmisano, Vitanio; Fisher, Michael; Drobni, Zsófia D; Kragelund, Charlotte; Aurelian, Rosca; Kelly, Stephanie; Del Blanco, Bruno Garcia; Rubio, Ainhoa; Boussoussou, Melinda; Hove, Jens D; Rodean, Ioana; Regan, Susan; Calabria, Hug Cuéllar; Becker, Dávid; Larsen, Linnea; Hodas, Roxana; Napp, Adriane E; Haase, Robert; Feger, Sarah; Mohamed, Mahmoud; Neumann, Konrad; Dreger, Henryk; Rief, Matthias; Wieske, Viktoria; Douglas, Pamela S; Estrella, Melanie; Bosserdt, Maria; Martus, Peter; Serna-Higuita, Lina M; Dodd, Jonathan D; Dewey, Marc.
In: European Radiology, 2024, p. 4127-4141.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial
AU - Mancone, Massimo
AU - Mézquita, Aldo J Vázquez
AU - Birtolo, Lucia Ilaria
AU - Maurovich-Horvat, Pal
AU - Kofoed, Klaus F
AU - Benedek, Theodora
AU - Donnelly, Patrick
AU - Rodriguez-Palomares, Jose
AU - Erglis, Andrejs
AU - Štěchovský, Cyril
AU - Šakalytė, Gintare
AU - Ađić, Nada Čemerlić
AU - Gutberlet, Matthias
AU - Diez, Ignacio
AU - Davis, Gershan
AU - Zimmermann, Elke
AU - Kępka, Cezary
AU - Vidakovic, Radosav
AU - Francone, Marco
AU - Ilnicka-Suckiel, Małgorzata
AU - Plank, Fabian
AU - Knuuti, Juhanni
AU - Faria, Rita
AU - Schröder, Stephen
AU - Berry, Colin
AU - Saba, Luca
AU - Ruzsics, Balazs
AU - Rieckmann, Nina
AU - Kubiak, Christine
AU - Hansen, Kristian Schultz
AU - Müller-Nordhorn, Jaqueline
AU - Merkely, Bela
AU - Sigvardsen, Per E
AU - Benedek, Imre
AU - Orr, Clare
AU - Valente, Filipa Xavier
AU - Zvaigzne, Ligita
AU - Suchánek, Vojtěch
AU - Jankauskas, Antanas
AU - Ađić, Filip
AU - Woinke, Michael
AU - Keane, Stephen
AU - Lecumberri, Ignacio
AU - Thwaite, Erica
AU - Kruk, Mariusz
AU - Jovanovic, Vladimir
AU - Kuśmierz, Donata
AU - Feuchtner, Gudren
AU - Pietilä, Mikko
AU - Ribeiro, Vasco Gama
AU - Drosch, Tanja
AU - Delles, Christian
AU - Palmisano, Vitanio
AU - Fisher, Michael
AU - Drobni, Zsófia D
AU - Kragelund, Charlotte
AU - Aurelian, Rosca
AU - Kelly, Stephanie
AU - Del Blanco, Bruno Garcia
AU - Rubio, Ainhoa
AU - Boussoussou, Melinda
AU - Hove, Jens D
AU - Rodean, Ioana
AU - Regan, Susan
AU - Calabria, Hug Cuéllar
AU - Becker, Dávid
AU - Larsen, Linnea
AU - Hodas, Roxana
AU - Napp, Adriane E
AU - Haase, Robert
AU - Feger, Sarah
AU - Mohamed, Mahmoud
AU - Neumann, Konrad
AU - Dreger, Henryk
AU - Rief, Matthias
AU - Wieske, Viktoria
AU - Douglas, Pamela S
AU - Estrella, Melanie
AU - Bosserdt, Maria
AU - Martus, Peter
AU - Serna-Higuita, Lina M
AU - Dodd, Jonathan D
AU - Dewey, Marc
N1 - © 2023. The Author(s), under exclusive licence to European Society of Radiology.
PY - 2024
Y1 - 2024
N2 - OBJECTIVES: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.MATERIALS AND METHODS: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).RESULTS: Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.CONCLUSION: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.CLINICAL RELEVANCE STATEMENT: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.TRIAL REGISTRATION: ClinicalTrials.gov NCT02400229.KEY POINTS: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
AB - OBJECTIVES: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.MATERIALS AND METHODS: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).RESULTS: Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.CONCLUSION: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.CLINICAL RELEVANCE STATEMENT: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.TRIAL REGISTRATION: ClinicalTrials.gov NCT02400229.KEY POINTS: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
U2 - 10.1007/s00330-023-10355-2
DO - 10.1007/s00330-023-10355-2
M3 - Journal article
C2 - 37991508
SP - 4127
EP - 4141
JO - European Radiology
JF - European Radiology
SN - 0938-7994
ER -
ID: 377783116