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CT versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

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posted on 2023-09-19, 21:45 authored by Theodora Benedek, Viktoria Wieske, Bálint Szilveszter, Klaus F Kofoed, Patrick Donnelly, José Rodriguez-Palomares, Andrejs Erglis, Josef Veselka, Gintarė Šakalytė, Nada Čemerlić Ađić, Matthias Gutberlet, 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, Nina Rieckmann, Christine Kubiak, Kristian Schultz Hansen, Jacqueline Müller-Nordhorn, Bela Merkely, Per E Sigvardsen, Imre Benedek, Clare Orr, Filipa Xavier Valente, Ligita Zvaigzne, Martin Horváth, Antanas Jankauskas, Filip Ađić, Michael Woinke, Niall Mulvihill, Iñigo Lecumberri, Erica Thwaite, Michael Laule, Mariusz Kruk, Milica Stefanovic, Massimo Mancone, Donata Kuśmierz, Gudrun Feuchtner, Mikko Pietilä, Vasco Gama Ribeiro, Tanja Drosch, Christian Delles, Marco Melis, Michael Fisher, Melinda Boussoussou, Charlotte Kragelund, Rosca Aurelian, Stephanie KellyStephanie Kelly, Bruno Garcia del Blanco, Ainhoa Rubio, Mihály Károlyi, Jens D. Hove, Ioana Rodean, Susan Regan, Hug Cuéllar-Calabria, László Gellér, Solveig Linnea Veen Larsen, Roxana Hodas, Adriane E. Napp, Robert HaaseRobert Haase, Sarah Feger, Mahmoud Mohamed, Lina M. Serna-Higuita, Konrad Neumann, Henryk Dreger, Matthias Rief, John Danesh, Melanie Estrella, Maria Bosserdt, Peter Martus, Jonathan D. Dodd, Marc Dewey

OBJECTIVES

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

RESEARCH DESIGN AND METHODS

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).

RESULTS

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]).

CONCLUSIONS

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.

Funding

This study was funded by grants from the EU-FP7 Framework Program (FP 2007-2013, EC-GA 603266) to MD and others (Berlin Institute of Health (grant from Digital Health Accelerator); British Heart Foundation (Centre of Research Excellence RE/18/6/34217); Rigshospitalet, University of Copenhagen (grant and nonfinancial support); and German Research Foundation (grants from Radiomics Priority Programme: DE 1361/19-1 [428222922] and 20-1 [428223139] in SPP2177/1) and grants from graduate program BIOQIC (GRK 2260/1 [289347353])). The DISCHARGE trial is associated with and endorsed by DZHK (German Centre for Cardiovascular Research and we greatly acknowledge this collaborative network.

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