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Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial
M. Mancone, AJV. Mézquita, LI. Birtolo, P. Maurovich-Horvat, KF. Kofoed, T. Benedek, P. Donnelly, J. Rodriguez-Palomares, A. Erglis, C. Štěchovský, G. Šakalytė, NČ. Ađić, M. Gutberlet, I. Diez, G. Davis, E. Zimmermann, C. Kępka, R. Vidakovic, M....
Language English Country Germany
Document type Journal Article, Randomized Controlled Trial, Multicenter Study, Pragmatic Clinical Trial
NLK
ProQuest Central
from 2024-01-01 to 1 year ago
CINAHL Plus with Full Text (EBSCOhost)
from 2008-01-01 to 1 year ago
Medline Complete (EBSCOhost)
from 2000-01-01 to 1 year ago
Nursing & Allied Health Database (ProQuest)
from 2024-01-01 to 1 year ago
Health & Medicine (ProQuest)
from 2024-01-01 to 1 year ago
- MeSH
- Coronary Angiography * methods MeSH
- Smoking * adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Coronary Artery Disease * diagnostic imaging complications MeSH
- Tomography, X-Ray Computed * methods MeSH
- Patient Discharge MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Pragmatic Clinical Trial MeSH
- Randomized Controlled Trial MeSH
OBJECTIVES: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. MATERIALS AND METHODS: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). RESULTS: Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. CONCLUSION: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. CLINICAL RELEVANCE STATEMENT: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. TRIAL REGISTRATION: ClinicalTrials.gov NCT02400229. KEY POINTS: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
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 Madrid Spain
County Clinical Emergency Hospital Targu Mures Targu Mures Romania
Department of Cardiology Aintree University Hospital Liverpool UK
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 Hospital of Lithuanian University of Health Sciences Kaunas Lithuania
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 FT Liverpool UK
Department of Cardiology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
Department of Cardiology Motol University Hospital Prague Czech Republic
Department of Cardiology Nordsjællands Hospital University of Copenhagen Copenhagen Denmark
Department of Cardiology Paul Stradins Clinical University Hospital Riga Latvia
Department of Cardiology Provincial Specialist Hospital in Wroclaw Wroclaw Poland
Department of Cardiology Southeastern Health and Social Care Trust Belfast UK
Department of Cardiology St Vincent's University Hospital Dublin Ireland
Department of Cardiology University of Leipzig Heart Centre Leipzig Germany
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
Department of Radiological Sciences Sapienza University of Rome Rome Italy
Department of Radiology Aintree University Hospital Liverpool UK
Department of Radiology and Neuroradiology SS Annunziata Hospital Taranto Italy
Department of Radiology Basurto Hospital Bilbao Spain
Department of Radiology Innsbruck Medical University Innsbruck Austria
Department of Radiology Medical Imaging Center Semmelweis University Budapest Hungary
Department of Radiology Motol University Hospital Prague Czech Republic
Department of Radiology Provincial Specialist Hospital in Wroclaw Wroclaw Poland
Department of Radiology St Vincent's University Hospital Dublin Ireland
Department of Radiology University of Cagliari Cagliari CA Italy
Department of Radiology University of Leipzig Heart Centre Leipzig Germany
Deutsches Herzzentrum Der Charité Berlin Germany
Deutsches Herzzentrum Der Charité Partner Site Berlin Berlin Germany
Deutsches Herzzentrum Der Charité Partner Site Berlin Germany
Duke Clinical Research Institute Duke University School of Medicine Durham NC USA
Edge Hill University Ormskirk UK
Faculty of Medicine University of Belgrade Belgrade Serbia
Faculty of Medicine University of Latvia Riga Latvia
Faculty of Medicine University of Novi Sad Novi Sad Serbia
Golden Jubilee National Hospital Clydebank UK
Heart and Vascular Center Semmelweis University Budapest Hungary
Heart Center Turku University Hospital and University of Turku Turku Finland
Liverpool Centre for Cardiovascular Studies University of Liverpool Liverpool UK
National Institute of Cardiology Warsaw Poland
School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UK
School of Medicine University College Dublin Dublin Ireland
Turku PET Centre Turku University Hospital and University of Turku Turku Finland
References provided by Crossref.org
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