CT or Invasive Coronary Angiography in Stable Chest Pain.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
28 04 2022
28 04 2022
Historique:
pubmed:
4
3
2022
medline:
30
4
2022
entrez:
3
3
2022
Statut:
ppublish
Résumé
In 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. We 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. 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; 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). 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 was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
Sections du résumé
BACKGROUND
In 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.
METHODS
We 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.
RESULTS
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; 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).
CONCLUSIONS
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 was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).
Identifiants
pubmed: 35240010
doi: 10.1056/NEJMoa2200963
doi:
Banques de données
ClinicalTrials.gov
['NCT02400229']
Types de publication
Journal Article
Multicenter Study
Pragmatic Clinical Trial
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1591-1602Subventions
Organisme : Københavns Universitet
ID : Grant and Non-Financial Support
Organisme : FP7 Health
ID : 603266
Organisme : Deutsche Forschungsgemeinschaft
ID : DE 1361/19-1 [428222922] and DE 1361/20-1 [4282231
Organisme : Berlin Institute of Health
ID : Digital Health Accelerator
Organisme : British Heart Foundation
ID : Centre of Research Excellence RE/18/6/34217
Pays : United Kingdom
Investigateurs
Béla Merkely
(B)
Pál Maurovich-Horvat
(P)
Thomas Engstroem
(T)
Klaus F Kofoed
(KF)
Imre Benedek
(I)
Theodora Benedek
(T)
Patrick Donnelly
(P)
José F Rodríguez-Palomares
(JF)
Bruno Garcia Del Blanco
(B)
Andrejs Erglis
(A)
Ligita Zvaigzne
(L)
Vojtěch Suchánek
(V)
Josef Veselka
(J)
Antanas Jankauskas
(A)
Gintare Šakalyte
(G)
Nada Čemerlić Ađić
(N)
Oto Ađić
(O)
Matthias Gutberlet
(M)
Michael Woinke
(M)
Jonathan D Dodd
(JD)
Martin Quinn
(M)
Ignacio Díez González
(I)
Inigo Lecumberri
(I)
Gershan K Davis
(GK)
Erika Thwaite
(E)
Michael Laule
(M)
Elke Zimmermann
(E)
Henryk Dreger
(H)
Matthias Rief
(M)
Cezary Kępka
(C)
Mariusz Kruk
(M)
Aleksandar N Neskovic
(AN)
Radosav Vidakovic
(R)
Marco Francone
(M)
Massiomo Mancone
(M)
Tomasz Haran
(T)
Malgorzata Ilnicka-Suckiel
(M)
Gudrun Feuchtner
(G)
Guy Friedrich
(G)
Juhani Knuuti
(J)
Mikko Pietilä
(M)
Rita Faria
(R)
Vasco Gama Ribeiro
(V)
Stephen Schröder
(S)
Thomas Zelesny
(T)
Christian Delles
(C)
Colin Berry
(C)
Bruno Loi
(B)
Gildo Matta
(G)
Michael Fisher
(M)
Balasz Ruzsics
(B)
Marc Dewey
(M)
Adriane E Napp
(AE)
Maria Bosserdt
(M)
Melanie Estrella
(M)
Jacob Geleijns
(J)
Christine Kubiak
(C)
Corinna Meier-Windhorst
(C)
Rita Pilger
(R)
Iñaki Gutiérrez-Ibarluzea
(I)
Nora Ibargoyen-Roteta
(N)
Itziar Etxeandia
(I)
Gaizka Benguria-Arrate
(G)
Lorea Galnares-Cordero
(L)
Karsten Vrangbaeck
(K)
Hans Keiding
(H)
Kristian Schultz Hansen
(K)
Jacqueline Müller-Nordhorn
(J)
Nina Rieckmann
(N)
Peter Schlattmann
(P)
Mihály Károlyi
(M)
Júlia Karády
(J)
Laszló Gellér
(L)
Levente Molnár
(L)
Tamás Bárány
(T)
István Édes
(I)
Dávid Becker
(D)
Száraz Lili Milan Vecsey-Nagy
(SL)
Borbala Vattay
(B)
Tem Jørgensen
(T)
Knut Lindvig
(K)
Charlotte Sørum
(C)
Helena Domínguez Vall-Lamora
(H)
Thomas Hermann
(T)
Charlotte Kragelund
(C)
Thomas Fritz Hansen
(T)
Jawdat Abdulla
(J)
Jens Dahlgaard Hove
(JD)
Kjeld Skødebjerg Kristensen
(KS)
Leah Hammond
(L)
Albert Roque Pérez
(A)
Imanol Otaegui Irurueta
(I)
Enzo Javier Alderete
(EJ)
Sebastian Albornoz
(S)
Karlis Strenge
(K)
Marina Berzina
(M)
Iveta Mintale
(I)
Marija Tokmanceva
(M)
Linda Glazere
(L)
Vita Saripo
(V)
Zanda Krastina
(Z)
Dace Sondore
(D)
Theodor Adla
(T)
Martin Horváth
(M)
Tadeáš Butta
(T)
Petra Hajžmanová
(P)
Audronė Vaitiekienė
(A)
Gediminas Jaruševičius
(G)
Kristina Morkūnaitė
(K)
Eglė Montrimavičienė
(E)
Laura Radionovaitė
(L)
Milenko Cankovic
(M)
Andrea Ljubotina
(A)
Christian Krieghoff
(C)
Robin Gohman
(R)
Fabian Juhrich
(F)
Patrick Seitz
(P)
Stephen Keane
(S)
Diarmaid Cadogan
(D)
Claire O'Dowling
(C)
Rudaynah A Alali
(RA)
Siobhan Quinlan
(S)
Edel Meaney
(E)
Peter Doran
(P)
Gerald Kearns
(G)
Siobhan O'Rourke
(S)
Sarah Foley
(S)
Joanne Clarke
(J)
Abdi Abdi
(A)
Aine Hahessy
(A)
Brian Meehan
(B)
Michelle Healy
(M)
Sonya Allen
(S)
Colin P Cantwell
(CP)
Niall Mulvihill
(N)
Charles McCreery
(C)
David Keane
(D)
Ken McDonald
(K)
Peter Quigley
(P)
Sadhbh O'Sullivan
(S)
Brian O'Riordan
(B)
Lara Toerien
(L)
John Irwin
(J)
Paddy Barrett
(P)
Dermot Malone
(D)
Abel Andres
(A)
Eva Amuriza
(E)
Arun Ranjit
(A)
Jaroslav Hasara
(J)
Mohammed Obeidat
(M)
Catherine Toohey
(C)
Sandra Fullalove
(S)
Kate Fenlon
(K)
Nicola Lawler
(N)
Anju Rawat
(A)
Francis Beni
(F)
Julie Ashcroft
(J)
Shirley Cooper
(S)
Jeanette Hawkins
(J)
Kate Hughes
(K)
Nicola Ashall
(N)
Doireann Dickinson
(D)
Gemma Halligan
(G)
Julie Rawcliffe
(J)
Dominik Laskowski
(D)
Anna-Maria Mielke
(AM)
Laura Elzenbeck
(L)
Daniel Preuß
(D)
Anne Karas
(A)
Anja Bärrn
(A)
Gustavo Gehling
(G)
Florian Specht
(F)
Lisa Timm
(L)
Karl Stangl
(K)
Verena Stangl
(V)
Anna Brand
(A)
Bernhard Föllmer
(B)
Eser Isler
(E)
Federico Biavati
(F)
Mahmoud Mohamed
(M)
Katrin Stoyanova
(K)
Bohdan Pryplotskyi
(B)
Christian Wald
(C)
Steffen Lukas
(S)
Anna Oleksiak
(A)
Vladimir Jovanovic
(V)
Aleksandra Maksimovic
(A)
Milica Stefanovic
(M)
Aleksandra Zivanic
(A)
Andrea Ceccacci
(A)
Gianluca De Rubeis
(G)
Giacomo Pambianchi
(G)
Paolo Severino
(P)
Tomasz Harań
(T)
Natalia Ilnicka
(N)
Katarzyna Romanowska
(K)
Tomasz Roleder
(T)
Christoph Beyer
(C)
Antti Saraste
(A)
Pedro Teixeira
(P)
Mónica Carvalho
(M)
Wilson Ferreira
(W)
Claúdia Dias
(C)
Nuno Ferreira
(N)
Raquel Menezes Fernandes
(R)
André Azul Freitas
(A)
Pedro Ribeiro Queirós
(P)
Lisa Maria Costa Ribeiro Ferraz
(LM)
Marion Steindl
(M)
Giles Roditi
(G)
Damien Collison
(D)
Laura Kelly
(L)
Katriona Brooksbank
(K)
Andrew Dougherty
(A)
Rosemary Woodward
(R)
Elizabeth Boyd
(E)
Kate Smith
(K)
Michele Porcu
(M)
Maurizio Porcu
(M)
Francesco Allegra
(F)
Vitanio Palmisano
(V)
Stefano Cossa
(S)
Alberto Boi
(A)
Marco Melis
(M)
Riccardo Cau
(R)
Christine Denby
(C)
Commentaires et corrections
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