Computed Tomography 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 , Ađić Nada Čemerlić , 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 , Schultz Hansen Kristian , Müller-Nordhorn Jacqueline , Merkely Bela , Sigvardsen Per E. , Benedek Imre , Orr Clare , Valente Filipa Xavier , 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 , Garcia del Blanco Bruno , Rubio Ainhoa , Károlyi Mihály , Hove Jens D. , Rodean Ioana , Regan Susan , Calabria Hug Cuéllar , Gellér László , Larsen Linnea , Hodas Roxana , Napp Adriane E. , Haase Robert , Feger Sarah , Mohamed Mahmoud , Serna-Higuita Lina M. , Neumann Konrad , Dreger Henryk , Rief Matthias , Danesh John , Estrella Melanie , Bosserdt Maria , Martus Peter , Dodd Jonathan D. , Dewey Marc 
Published: September 2023

OBJECTIVE
To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain.

RESEARCH DESIGN AND METHODS
This prespecified analysis of the multicenter DISCHARGE trial (NCT02400229) in 16 European countries was performed in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary end point was a major adverse cardiac event (MACE) (cardiovascular death, nonfatal myocardial infarction, or stroke), and the secondary end point was expanded MACE (including transient ischemic attacks and major procedure-related complications).

RESULTS
Follow-up at a median of 3.5 years was available in 3,541 patients of whom 557 (CT group n = 263 vs. ICA group n = 294) had diabetes and 2,984 (CT group n = 1,536 vs. ICA group n = 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 end point occurred less frequently in the CT group than in the ICA group (3.8% [10 of 263] vs. 8.2% [24 of 294], hazard ratio [HR] 0.45 [95% CI 0.22–0.95]), as did the major procedure-related complication rate (0.4% [1 of 263] vs. 2.7% [8 of 294], HR 0.30 [95% CI 0.13 – 0.63]).

CONCLUSIONS
In patients with diabetes referred for 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.