Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial
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Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain : A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial. / Bosserdt, Maria; Serna-Higuita, Lina M; Feuchtner, Gudrun; Merkely, Bela; Kofoed, Klaus F; Benedek, Theodora; Donnelly, Patrick; Rodriguez-Palomares, José; Erglis, Andrejs; Štechovský, Cyril; Šakalyte, Gintare; Adic, Nada Cemerlic; Gutberlet, Matthias; Dodd, Jonathan D; Diez, Ignacio; Davis, Gershan; Zimmermann, Elke; Kepka, Cezary; Vidakovic, Radosav; Francone, Marco; Ilnicka-Suckiel, Malgorzata; Plank, Fabian; Knuuti, Juhani; Faria, Rita; Schröder, Stephen; Berry, Colin; Saba, Luca; Ruzsics, Balazs; Rieckmann, Nina; Kubiak, Christine; Hansen, Kristian Schultz; Müller-Nordhorn, Jacqueline; Szilveszter, Bálint; Sigvardsen, Per E; Benedek, Imre; Orr, Clare; Valente, Filipa Xavier; Zvaigzne, Ligita; Suchánek, Vojtech; Jankauskas, Antanas; Adic, Filip; Woinke, Michael; Hensey, Mark; Lecumberri, Iñigo; Thwaite, Erica; Laule, Michael; Kruk, Mariusz; Kragelund, Charlotte; Hove, Jens D; Larsen, Linnea; DISCHARGE Trial Group.
I: JAMA Cardiology, Bind 9, Nr. 4, 2024, s. 346-356.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain
T2 - A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial
AU - Bosserdt, Maria
AU - Serna-Higuita, Lina M
AU - Feuchtner, Gudrun
AU - Merkely, Bela
AU - Kofoed, Klaus F
AU - Benedek, Theodora
AU - Donnelly, Patrick
AU - Rodriguez-Palomares, José
AU - Erglis, Andrejs
AU - Štechovský, Cyril
AU - Šakalyte, Gintare
AU - Adic, Nada Cemerlic
AU - Gutberlet, Matthias
AU - Dodd, Jonathan D
AU - Diez, Ignacio
AU - Davis, Gershan
AU - Zimmermann, Elke
AU - Kepka, Cezary
AU - Vidakovic, Radosav
AU - Francone, Marco
AU - Ilnicka-Suckiel, Malgorzata
AU - Plank, Fabian
AU - Knuuti, Juhani
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, Jacqueline
AU - Szilveszter, Bálint
AU - Sigvardsen, Per E
AU - Benedek, Imre
AU - Orr, Clare
AU - Valente, Filipa Xavier
AU - Zvaigzne, Ligita
AU - Suchánek, Vojtech
AU - Jankauskas, Antanas
AU - Adic, Filip
AU - Woinke, Michael
AU - Hensey, Mark
AU - Lecumberri, Iñigo
AU - Thwaite, Erica
AU - Laule, Michael
AU - Kruk, Mariusz
AU - Kragelund, Charlotte
AU - Hove, Jens D
AU - Larsen, Linnea
AU - DISCHARGE Trial Group
PY - 2024
Y1 - 2024
N2 - IMPORTANCE: The effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown.OBJECTIVE: To determine the association of age with outcomes of CT and ICA in patients with stable chest pain.DESIGN, SETTING, AND PARTICIPANTS: The assessor-blinded Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial was conducted between October 2015 and April 2019 in 26 European centers. Patients referred for ICA with stable chest pain and an intermediate probability of obstructive coronary artery disease were analyzed in an intention-to-treat analysis. Data were analyzed from July 2022 to January 2023.INTERVENTIONS: Patients were randomly assigned to a CT-first strategy or a direct-to-ICA strategy.MAIN OUTCOMES AND MEASURES: MACE (ie, cardiovascular death, nonfatal myocardial infarction, or stroke) and major procedure-related complications. The primary prespecified outcome of this secondary analysis of age was major adverse cardiovascular events (MACE) at a median follow-up of 3.5 years.RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 2360 (66.3%) were younger than 65 years, 982 (27.6%) were between ages 65 to 75 years, and 219 (6.1%) were older than 75 years. The primary outcome was MACE at a median (IQR) follow-up of 3.5 (2.9-4.2) years for 3523 patients (99%). Modeling age as a continuous variable, age, and randomization group were not associated with MACE (hazard ratio, 1.02; 95% CI, 0.98-1.07; P for interaction = .31). Age and randomization group were associated with major procedure-related complications (odds ratio, 1.15; 95% CI, 1.05-1.27; P for interaction = .005), which were lower in younger patients.CONCLUSIONS AND RELEVANCE: Age did not modify the effect of randomization group on the primary outcome of MACE but did modify the effect on major procedure-related complications. Results suggest that CT was associated with a lower risk of major procedure-related complications in younger patients.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.
AB - IMPORTANCE: The effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown.OBJECTIVE: To determine the association of age with outcomes of CT and ICA in patients with stable chest pain.DESIGN, SETTING, AND PARTICIPANTS: The assessor-blinded Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial was conducted between October 2015 and April 2019 in 26 European centers. Patients referred for ICA with stable chest pain and an intermediate probability of obstructive coronary artery disease were analyzed in an intention-to-treat analysis. Data were analyzed from July 2022 to January 2023.INTERVENTIONS: Patients were randomly assigned to a CT-first strategy or a direct-to-ICA strategy.MAIN OUTCOMES AND MEASURES: MACE (ie, cardiovascular death, nonfatal myocardial infarction, or stroke) and major procedure-related complications. The primary prespecified outcome of this secondary analysis of age was major adverse cardiovascular events (MACE) at a median follow-up of 3.5 years.RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 2360 (66.3%) were younger than 65 years, 982 (27.6%) were between ages 65 to 75 years, and 219 (6.1%) were older than 75 years. The primary outcome was MACE at a median (IQR) follow-up of 3.5 (2.9-4.2) years for 3523 patients (99%). Modeling age as a continuous variable, age, and randomization group were not associated with MACE (hazard ratio, 1.02; 95% CI, 0.98-1.07; P for interaction = .31). Age and randomization group were associated with major procedure-related complications (odds ratio, 1.15; 95% CI, 1.05-1.27; P for interaction = .005), which were lower in younger patients.CONCLUSIONS AND RELEVANCE: Age did not modify the effect of randomization group on the primary outcome of MACE but did modify the effect on major procedure-related complications. Results suggest that CT was associated with a lower risk of major procedure-related complications in younger patients.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.
U2 - 10.1001/jamacardio.2024.0001
DO - 10.1001/jamacardio.2024.0001
M3 - Journal article
C2 - 38416472
VL - 9
SP - 346
EP - 356
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 4
ER -
ID: 386144023