CT safer option than invasive coronary angiography for patients with stable chest pain: NEJM
Germany: Computed Tomography safer option than invasive coronary angiography for diagnosing coronary artery disease as frequency of major procedure-related complications was shown to be lower with an initial CT strategy.
But the risk of major adverse cardiovascular events was found to be similar in the computed tomography (CT) group and the invasive coronary angiography (ICA) group in patients referred for ICA owing to stable chest pain and intermediate pretest probability of CAD.
The study has been published in the New England Journal of Medicine.
Computed tomography and invasive coronary angiography have shown almost the same accurate results in the diagnosis of obstructive coronary artery disease (CAD). However, uncertainty exists regarding the comparative effectiveness of CT and ICA for CAD management to reduce the frequency of major adverse cardiovascular events.
Considering the above, The Discharge Trial group, compared CT with ICA as 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 in a pragmatic, randomized trial. Major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years were the primary outcome. Key secondary outcomes were procedure-related complications and angina pectoris.
Based on the study, the researchers found the following:
- Among 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).
- 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).
- 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).
To conclude, among 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 however was lower with an initial CT strategy.
Reference:
The study titled, "CT or Invasive Coronary Angiography in Stable Chest Pain," was published in the New England Journal of Medicine.
DOI: 10.1056/NEJMoa2200963
