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Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
T. Benedek, V. Wieske, B. Szilveszter, KF. Kofoed, P. Donnelly, J. Rodriguez-Palomares, A. Erglis, J. Veselka, G. Šakalytė, NČ. Ađić, M. Gutberlet, I. Diez, G. Davis, E. Zimmermann, C. Kępka, R. Vidakovic, M. Francone, M. Ilnicka-Suckiel, F....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu multicentrická studie, časopisecké články, práce podpořená grantem
Open Access Digital Library od 1978-01-01 do Před 6 měsíci
Open Access Digital Library od 2000-01-01 do Před 6 měsíci
Medline Complete (EBSCOhost) od 1978-01-01
Odkazy
PubMed
37725834
DOI
10.2337/dc23-0710
Knihovny.cz E-zdroje
- MeSH
- bolesti na hrudi MeSH
- CT angiografie MeSH
- diabetes mellitus * epidemiologie MeSH
- koronární angiografie metody MeSH
- lidé MeSH
- nemoci koronárních tepen * diagnostické zobrazování MeSH
- počítačová rentgenová tomografie MeSH
- prediktivní hodnota testů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
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 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.
Administrative Centre Health Care District of Southwestern Finland Turku Finland
Bavarian Cancer Registry Bavarian Health and Food Safety Authority Munich Germany
Berlin Institute of Health at Charité Universitätsmedizin Berlin Berlin Germany
Berlin University Alliance Berlin Germany
Centro de Investigacion Biomedica en Red CIBERCV Madrid Spain
County Clinical Emergency Hospital Targu Mures Targu Mures Romania
Department of Cardiology Aintree University Hospital Liverpool U K
Department of Cardiology Alb Fils Kliniken Göppingen Germany
Department of Cardiology Basurto Hospital Bilbao Spain
Department of Cardiology Centro Hospitalar de Vila Nova de Gaia Espinho Vila Nova de Gaia Portugal
Department of Cardiology Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark
Department of Cardiology Herlev Gentofte Hospital Hellerup Denmark
Department of Cardiology Institute for Cardiovascular Diseases of Vojvodina Novi Sad Serbia
Department of Cardiology Internal Medicine Clinic Clinical Hospital Center Zemun Belgrade Serbia
Department of Cardiology Liverpool University Hospital NHS Foundation Trust Liverpool U K
Department of Cardiology Motol University Hospital Prague Czech Republic
Department of Cardiology Nordsjællands Hospital University of Copenhagen Hillerød Denmark
Department of Cardiology Paul Stradins Clinical University Hospital University of Latvia Riga Latvia
Department of Cardiology Provincial Specialist Hospital in Wrocław Wrocław Poland
Department of Cardiology Southeastern Health and Social Care Trust Belfast U K
Department of Cardiology St Vincent's University Hospital Dublin Ireland
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
Department of Public Health and Primary Care at Cambridge University Cambridge U K
Department of Radiological Sciences Sapienza University of Rome Italy
Department of Radiology Azienda Ospedaliero Universitaria Cagliari Italy
Department of Radiology Innsbruck Medical University Innsbruck Austria
Department of Radiology Provincial Specialist Hospital in Wrocław Wrocław Poland
Department of Radiology St Vincent's University Hospital Dublin Ireland
Department of Radiology University of Leipzig Heart Centre Leipzig Germany
Deutsches Herzzentrum der Charité Berlin Germany
Edge Hill University Ormskirk U K
Faculty of Health and Life Sciences University of Liverpool Liverpool U K
Faculty of Medicine University of Belgrade Belgrade Serbia
Faculty of Medicine University of Novi Sad Novi Sad Serbia
German Centre for Cardiovascular Research Partner Site Berlin Germany
Golden Jubilee National Hospital Clydebank U K
Heart and Vascular Center Semmelweis University Budapest Hungary
Institute for Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital Liverpool U K
National Institute of Cardiology Warsaw Poland
School of Cardiovascular and Metabolic Health University of Glasgow Glasgow U K
School of Medicine University College Dublin Dublin Ireland
Turku PET Centre Turku University Hospital and University of Turku Turku Finland
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- $a Benedek, Theodora $u Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania $u County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania
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- $a Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease / $c T. Benedek, V. Wieske, B. Szilveszter, KF. Kofoed, P. Donnelly, J. Rodriguez-Palomares, A. Erglis, J. Veselka, G. Šakalytė, NČ. Ađić, M. Gutberlet, I. Diez, G. Davis, E. Zimmermann, C. Kępka, R. Vidakovic, M. Francone, M. Ilnicka-Suckiel, F. Plank, J. Knuuti, R. Faria, S. Schröder, C. Berry, L. Saba, B. Ruzsics, N. Rieckmann, C. Kubiak, K. Schultz Hansen, J. Müller-Nordhorn, B. Merkely, PE. Sigvardsen, I. Benedek, C. Orr, FX. Valente, L. Zvaigzne, M. Horváth, A. Jankauskas, F. Ađić, M. Woinke, N. Mulvihill, I. Lecumberri, E. Thwaite, M. Laule, M. Kruk, M. Stefanovic, M. Mancone, D. Kuśmierz, G. Feuchtner, M. Pietilä, VG. Ribeiro, T. Drosch, C. Delles, M. Melis, M. Fisher, M. Boussoussou, C. Kragelund, R. Aurelian, S. Kelly, B. Garcia Del Blanco, A. Rubio, M. Károlyi, JD. Hove, I. Rodean, S. Regan, HC. Calabria, L. Gellér, L. Larsen, R. Hodas, AE. Napp, R. Haase, S. Feger, M. Mohamed, LM. Serna-Higuita, K. Neumann, H. Dreger, M. Rief, J. Danesh, M. Estrella, M. Bosserdt, P. Martus, JD. Dodd, M. Dewey
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- $a 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 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.
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