DISCHARGE
Trial question
Is CT superior to invasive coronary angiography in guideline-directed management of stable chest pain?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
56.0% female
44.0% male
N = 3561
3561 patients (2002 female, 1559 male).
Inclusion criteria: patients with stable chest pain who had an intermediate pretest probability of obstructive coronary artery disease and were referred for invasive coronary angiography.
Key exclusion criteria: receipt of hemodialysis; absence of sinus rhythm; pregnancy.
Interventions
N=1808 CT (clinical management decisions based on coronary CTA).
N=1753 invasive coronary angiography (clinical management decisions based on invasive coronary angiography).
Primary outcome
Rate of composite outcome of CV death, nonfatal MI, or nonfatal stroke over 3.5 years
2.1%
3%
3.0 %
2.3 %
1.5 %
0.8 %
0.0 %
Computed
tomography
Invasive coronary
angiography
No significant
difference ↔
No significant difference in the rate of composite outcome of CV death, nonfatal MI, or nonfatal stroke over 3.5 years (2.1% vs. 3%; HR 0.7, 95% CI 0.46 to 1.07).
Secondary outcomes
Significant decrease in major procedure-related complications (0.5% vs. 1.9%; HR 0.26, 95% CI 0.13 to 0.55).
No significant difference in the rate of angina during at the last 4 weeks of follow-up (8.8% vs. 7.5%; OR 1.17, 95% CI 0.92 to 1.48).
No significant difference in EuroQol 5-Dimension VAS score (71.8 points vs. 71.1 points; MD 0.31, 95% CI -0.76 to 1.38).
Conclusion
In patients with stable chest pain who had an intermediate pretest probability of obstructive coronary artery disease and were referred for invasive coronary angiography, CT was not superior to invasive coronary angiography with respect to the rate of composite outcome of CV death, nonfatal MI, or nonfatal stroke over 3.5 years.
Reference
DISCHARGE Trial Group, Pál Maurovich-Horvat, Maria Bosserdt et al. CT or Invasive Coronary Angiography in Stable Chest Pain. N Engl J Med. 2022 Apr 28;386(17):1591-1602.
Open reference URL