Computed tomography preferred over ICA for diagnosing CAD in younger patients with chest pain, suggests study
USA: A prespecified secondary analysis of the DISCHARGE randomized clinical trial including 3561 patients with stable chest pain determined if age is associated with the clinical outcomes after coronary computed tomography (CT) and invasive coronary angiography (ICA). The findings were published online in JAMA Cardiology on February 28, 2024.
The study revealed that age did not modify the effect of the randomization group on the primary outcome of MACE (major adverse cardiovascular events); study results showed that major procedure-related complications were linked with age and the randomization group, being lower in younger patients receiving CT.
Based on the study, the researchers suggested considering CT as the preferred method for younger patients in cardiac outcomes related to major procedure-related complications.
ICA is an established technique for the diagnosis and treatment of obstructive coronary artery disease (CAD), but coronary CT is a noninvasive alternative for ruling out obstructive CAD in stable chest pain patients. However, the choice between the two can be difficult. Age is a cardiovascular risk factor, but it is unknown whether it should be a factor in deciding between ICA or CT.
A team led by the DISCHARGE Trial Group sought to determine the association of age with outcomes of CT and ICA in patients with stable chest pain using data from the DISCHARGE trial. They measured the effect of age on the rate of procedure-related complications of the two techniques.
The primary outcome was MACE (i.e., cardiovascular death, stroke, or nonfatal myocardial infarction) and major procedure-related complications. The primary prespecified outcome of this secondary analysis of age was MACE at a median follow-up of 3.5 years.
The group included data from 3,561 patients with an average age of 60.1. Of these, 66.3% were younger than 65, 27.6% were between 65 and 75 years of age, and 6.1% were older than 75. The patients were randomly placed into CT or ICA groups.
The following were the key findings of the study:
- The primary outcome was MACE at a median follow-up of 3.5 years for 99% of the patients.
- Modelling age as a continuous variable, age, and randomization group were not associated with MACE (hazard ratio, 1.02).
- Age and randomization group were associated with major procedure-related complications (odds ratio, 1.15), which were lower in younger patients.
To conclude, age did not modify the effect of the randomization group on MACE but did modify the effect on major procedure-related complications.
"Results suggest that computed tomography was linked with a lower risk of major procedure-related complications in younger patients," the researchers wrote.
Reference:
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. Published online February 28, 2024. doi:10.1001/jamacardio.2024.0001
