CT versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
Authors: Benedek Theodora , Wieske Viktoria , Szilveszter Bálint , Kofoed Klaus F , Donnelly Patrick , Rodriguez-Palomares José , Erglis Andrejs , Veselka Josef , Šakalytė Gintarė , Čemerlić Ađić Nada , Gutberlet Matthias , Diez Ignacio , Davis Gershan , Zimmermann Elke , Kępka Cezary , Vidakovic Radosav , Francone Marco , Ilnicka-Suckiel, Małgorzata , Plank Fabian , Knuuti Juhani , Faria Rita , Schröder Stephen , Berry Colin , Saba Luca , Ruzsics Balazs , Rieckmann Nina , Kubiak Christine , Hansen Kristian Schultz , Müller-Nordhorn Jacqueline , Merkely Bela , Sigvardsen Per E , Benedek Imre , Orr Clare , Xavier Valente Filipa , Zvaigzne Ligita , Horváth Martin , Jankauskas Antanas , Ađić Filip , Woinke Michael , Mulvihill Niall , Lecumberri Iñigo , Thwaite Erica , Laule Michael , Kruk Mariusz , Stefanovic Milica , Mancone Massimo , Kuśmierz Donata , Feuchtner Gudrun , Pietilä Mikko , Ribeiro Vasco Gama , Drosch Tanja , Delles Christian , Melis Marco , Fisher Michael , Boussoussou Melinda , Kragelund Charlotte , Aurelian Rosca , Kelly Stephanie , del Blanco Bruno Garcia , Rubio Ainhoa , Károlyi Mihály , Hove Jens D. , Rodean Ioana , Regan Susan , Cuéllar-Calabria Hug , Gellér László , Larsen Solveig Linnea Veen , Hodas Roxana , E. Napp Adriane , Haase Robert , Feger Sarah , Mohamed Mahmoud , M. Serna-Higuita Lina , Neumann Konrad , Dreger Henryk , Rief Matthias , Danesh John , Estrella Melanie , Bosserdt Maria , Martus Peter , D. Dodd Jonathan , Dewey Marc 
Published: September 2023

<p dir="ltr">OBJECTIVES</p><p dir="ltr">To compare cardiac CT with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain.</p><p dir="ltr">RESEARCH DESIGN AND METHODS </p><p dir="ltr">This was a prespecified analysis of the multicenter DISCHARGE trial (NCT02400229) in 16 European countries in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary endpoint was MACE (cardiovascular death, nonfatal myocardial infarction, or stroke) and the secondary endpoint was expanded MACE (including transient ischemic attacks and major procedure-related complications).</p><p dir="ltr">RESULTS </p><p dir="ltr">Follow-up at a median of 3.5 years was available in 3,541 patients, 557 (CT:263 vs. ICA:294) had diabetes and 2,984 (CT:1,536; ICA:1,448) did not. No statistically significant diabetes interaction was found for MACE (P = 0.45), expanded MACE (P=0.35), or major procedure-related complications (P=0.49). In both patients with and without diabetes, the rate of MACE did not differ between CT and ICA groups. In patients with diabetes, the expanded MACE endpoint occurred less frequently in the CT group than in the ICA group 3.8% [10/263] vs 8.2% [24/294], (HR: 0.45 [0.22-0.95]) as did the major procedure-related complication rate 0.4% [1/263] vs 2.7% [8/294], (HR: 0.30, [0.13 – 0.63]). </p><p dir="ltr">CONCLUSIONS </p><p dir="ltr">In patients with diabetes referred to ICA for the investigation of stable chest pain, a CT-first strategy compared with an ICA-first strategy showed no difference in MACE and may potentially be associated with a lower rate of expanded MACE and major procedure-related complications.</p>