CT or Invasive Coronary Angiography in Stable Chest Pain
Authors: Pál Maurovich-Horvat, Maria Bosserdt, Klaus F Kofoed, Nina Rieckmann, Theodora Benedek, Patrick Donnelly, José Rodriguez-Palomares, Andrejs Erglis, Cyril Štěchovský, Gintare Šakalyte, Nada Čemerlić Adić, Matthias Gutberlet, Jonathan D Dodd, Ignacio Diez, Gershan Davis, Elke Zimmermann, Cezary Kępka, Radosav Vidakovic, Marco Francone, Małgorzata Ilnicka-Suckiel, Fabian Plank, Juhani Knuuti, Rita Faria, Stephen Schröder, Colin Berry, Luca Saba, Balazs Ruzsics, Christine Kubiak, Iñaki Gutierrez-Ibarluzea, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Andreas D Knudsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Vojtěch Suchánek, Laura Zajančkauskiene, Filip Adić, Michael Woinke, Mark Hensey, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Aleksandar N Neskovic, Massimo Mancone, Donata Kuśmierz, Gudrun Feuchtner, Mikko Pietilä, Vasco Gama Ribeiro, Tanja Drosch, Christian Delles, Gildo Matta, Michael Fisher, Bálint Szilveszter, Linnea Larsen, Mihaela Ratiu, Stephanie Kelly, Bruno Garcia Del Blanco, Ainhoa Rubio, Zsófia D Drobni, Birgit Jurlander, Ioana Rodean, Susan Regan, Hug Cuéllar Calabria, Melinda Boussoussou, Thomas Engstrøm, Roxana Hodas, Adriane E Napp, Robert Haase, Sarah Feger, Lina M Serna-Higuita, Konrad Neumann, Henryk Dreger, Matthias Rief, Viktoria Wieske, Melanie Estrella, Peter Martus, Marc Dewey
Journal: New England Journal of Medicine (2022)

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.).