CT or Invasive Coronary Angiography in Stable Chest Pain
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CT or Invasive Coronary Angiography in Stable Chest Pain. / Maurovich-Horvat, Pal; Bosserdt, Maria; Kofoed, Klaus F.; Rieckmann, Nina; Benedek, Theodora; Donnelly, Patrick; Rodriguez-Palomares, Jose; Erglis, Andrejs; Stechovsk, Cyril; Sakalyte, 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; Schroder, Stephen; Berry, Colin; Saba, Luca; Ruzsics, Balazs; Kubiak, Christine; Gutierrez-Ibarluzea, Inaki; Hansen, Kristian Schultz; Muller-Nordhorn, Jacqueline; Merkely, Bela; Knudsen, Andreas D.; Benedek, Imre; Orr, Clare; Valente, Filipa Xavier; Zvaigzne, Ligita; Suchanek, Vojtech; Zajanckauskiene, Laura; Adic, Flip; Woinke, Michael; Hensey, Mark; Lecumberri, Inigo; Thwaite, Erica; Laule, Michael; Kruk, Mariusz; Neskovic, Aleksandar N.; Larsen, Linnea; Jurlander, Birgit; Engstrom, Thomas; DISCHARGE Trial Grp.
I: New England Journal of Medicine, Bind 386, 2022, s. 1591-1602.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - CT or Invasive Coronary Angiography in Stable Chest Pain
AU - Maurovich-Horvat, Pal
AU - Bosserdt, Maria
AU - Kofoed, Klaus F.
AU - Rieckmann, Nina
AU - Benedek, Theodora
AU - Donnelly, Patrick
AU - Rodriguez-Palomares, Jose
AU - Erglis, Andrejs
AU - Stechovsk, Cyril
AU - Sakalyte, 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 - Schroder, Stephen
AU - Berry, Colin
AU - Saba, Luca
AU - Ruzsics, Balazs
AU - Kubiak, Christine
AU - Gutierrez-Ibarluzea, Inaki
AU - Hansen, Kristian Schultz
AU - Muller-Nordhorn, Jacqueline
AU - Merkely, Bela
AU - Knudsen, Andreas D.
AU - Benedek, Imre
AU - Orr, Clare
AU - Valente, Filipa Xavier
AU - Zvaigzne, Ligita
AU - Suchanek, Vojtech
AU - Zajanckauskiene, Laura
AU - Adic, Flip
AU - Woinke, Michael
AU - Hensey, Mark
AU - Lecumberri, Inigo
AU - Thwaite, Erica
AU - Laule, Michael
AU - Kruk, Mariusz
AU - Neskovic, Aleksandar N.
AU - Larsen, Linnea
AU - Jurlander, Birgit
AU - Engstrom, Thomas
AU - DISCHARGE Trial Grp
PY - 2022
Y1 - 2022
N2 - BACKGROUNDIn 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.METHODSWe 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.RESULTSAmong 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).CONCLUSIONSAmong 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.
AB - BACKGROUNDIn 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.METHODSWe 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.RESULTSAmong 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).CONCLUSIONSAmong 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.
KW - GUIDELINES
KW - MANAGEMENT
KW - ANGINA
KW - PCI
U2 - 10.1056/NEJMoa2200963
DO - 10.1056/NEJMoa2200963
M3 - Journal article
C2 - 35240010
VL - 386
SP - 1591
EP - 1602
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
ER -
ID: 300370859