DISCHARGE Trial: CT and Invasive Angiography Offer Comparable Long-Term Benefits in Stable Chest Pain

The study, conducted by Jonathan D. Dodd, MD, Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland, and colleagues, included 3,561 patients (average age around 60 years, 56% women) from 26 centers in Europe.

Participants were randomly assigned to either CT or ICA as their initial diagnostic approach and were followed for a median period of 3.5 years. Health status outcomes were assessed using validated patient-reported tools such as the EQ-5D-3L visual analog scale (VAS), the Short Form-12 (SF-12) physical and mental health surveys, and the Hospital Anxiety and Depression Scale (HADS).

The key findings include the following:

• The CT and ICA groups experienced significant improvements in overall quality of life (QOL) scores over the 3.5-year follow-up period.
• The EQ-5D-3L-VAS scores increased by 4.0 points in the CT group and 4.6 points in the ICA group from baseline to 3.5 years.
• There were similar improvements in other QOL domains, including physical functioning and mental well-being.
• There was no significant difference between the CT and ICA groups in terms of chest pain (angina) relief at 3.5 years.
• Female participants consistently reported lower QOL scores than males at the beginning and the study's end.
• Despite lower baseline scores, women showed greater relative improvement in physical health, mental health, and anxiety levels over time.
• Persistent chest pain was more likely among patients who had higher chest pain intensity at baseline, depressive symptoms, and those who were female, irrespective of the diagnostic method used.
• A statistically significant improvement in depression scores over time was observed only in the CT group.

Researchers found that CT-first and ICA-first diagnostic strategies led to meaningful improvements in quality of life (QOL) for patients with stable chest pain. Over a follow-up period of one year and extending to a median of 3.5 years, participants in both groups—regardless of sex—experienced significant gains in QOL, with no major differences observed between the two diagnostic pathways.

According to the study authors, these findings carry valuable implications for clinical practice. Since both tests offer comparable long-term benefits for symptom relief and quality of life, clinicians can confidently inform patients that either option is likely to yield similar outcomes. This enables a more personalized and informed discussion, allowing patients to weigh procedural risks, comfort, accessibility, and personal preferences when deciding on a diagnostic strategy.

The analysis shows the relevance of considering sex-based differences in health outcomes, as female participants reported lower baseline QOL scores than males. Women demonstrated relatively greater improvements in several health domains, including physical and mental well-being and anxiety levels.

"Overall, the results support the use of non-invasive CT as an effective alternative to invasive coronary angiography in stable chest pain management, reinforcing the importance of shared decision-making tailored to individual patient needs," the researchers concluded.

Reference:

The DISCHARGE Trial Group. Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial. JAMA Cardiol. Published online May 14, 2025. doi:10.1001/jamacardio.2025.0992