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Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial
DISCHARGE Trial Group, M. Bosserdt, LM. Serna-Higuita, G. Feuchtner, B. Merkely, KF. Kofoed, T. Benedek, P. Donnelly, J. Rodriguez-Palomares, A. Erglis, C. Štechovský, G. Šakalyte, NC. Adic, M. Gutberlet, JD. Dodd, I. Diez, G. Davis, E....
Language English Country United States
Document type Randomized Controlled Trial, Journal Article
- MeSH
- Chest Pain etiology diagnosis MeSH
- Coronary Angiography methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Coronary Artery Disease * complications diagnostic imaging MeSH
- Tomography, X-Ray Computed MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
IMPORTANCE: The effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown. OBJECTIVE: To determine the association of age with outcomes of CT and ICA in patients with stable chest pain. DESIGN, SETTING, AND PARTICIPANTS: The assessor-blinded Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial was conducted between October 2015 and April 2019 in 26 European centers. Patients referred for ICA with stable chest pain and an intermediate probability of obstructive coronary artery disease were analyzed in an intention-to-treat analysis. Data were analyzed from July 2022 to January 2023. INTERVENTIONS: Patients were randomly assigned to a CT-first strategy or a direct-to-ICA strategy. MAIN OUTCOMES AND MEASURES: MACE (ie, cardiovascular death, nonfatal myocardial infarction, or stroke) and major procedure-related complications. The primary prespecified outcome of this secondary analysis of age was major adverse cardiovascular events (MACE) at a median follow-up of 3.5 years. RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 2360 (66.3%) were younger than 65 years, 982 (27.6%) were between ages 65 to 75 years, and 219 (6.1%) were older than 75 years. The primary outcome was MACE at a median (IQR) follow-up of 3.5 (2.9-4.2) years for 3523 patients (99%). Modeling age as a continuous variable, age, and randomization group were not associated with MACE (hazard ratio, 1.02; 95% CI, 0.98-1.07; P for interaction = .31). Age and randomization group were associated with major procedure-related complications (odds ratio, 1.15; 95% CI, 1.05-1.27; P for interaction = .005), which were lower in younger patients. CONCLUSIONS AND RELEVANCE: Age did not modify the effect of randomization group on the primary outcome of MACE but did modify the effect on major procedure-related complications. Results suggest that CT was associated with a lower risk of major procedure-related complications in younger patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.
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
Centro de Investigacion Biomedica en Red Madrid Spain
County Clinical Emergency Hospital Targu Mures Targu Mures Romania
Department of Biomedical Sciences Humanitas University Milan Italy
Department of Cardiology Aintree University Hospital Liverpool United Kingdom
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 Foundation Trust Liverpool United Kingdom
Department of Cardiology Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
Department of Cardiology Motol University Hospital Prague Czech Republic
Department of Cardiology Nordsjaellands Hospital University of Copenhagen Hilleroed Denmark
Department of Cardiology Paul Stradins Clinical University Hospital Riga Latvia
Department of Cardiology Provincial Specialist Hospital in Wrocław Wrocław Poland
Department of Cardiology Southeastern Health and Social Care Trust Belfast United Kingdom
Department of Cardiology St Vincent's University Hospital and School of Medicine Dublin Ireland
Department of Cardiology University of Leipzig Heart Centre Leipzig Germany
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
Department of Imaging Methods Motol University Hospital Prague Czech Republic
Department of Radiology Aintree University Hospital Liverpool United Kingdom
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 Paul Stradins Clinical University Hospital Riga Latvia
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 Cagliari Cagliari Italy
Department of Radiology University of Leipzig Heart Centre Leipzig Germany
Deutsches Herzzentrum der Charité Berlin Germany
DZHK partner site Berlin Germany
Edge Hill University Ormskirk United Kingdom
Faculty of Health and Life Sciences University of Liverpool Liverpool United Kingdom
Faculty of Medicine University of Belgrade Belgrade Serbia
Faculty of Medicine University of Novi Sad Novi Sad Serbia
Geisel School of Medicine at Dartmouth Hanover New Hampshire
Golden Jubilee National Hospital Clydebank United Kingdom
Heart and Vascular Center Semmelweis University Budapest Hungary
Heart Center Turku University Hospital and University of Turku Turku Finland
National Institute of Cardiology Warsaw Poland
School of Cardiovascular and Metabolic Health University of Glasgow Glasgow United Kingdom
School of Medicine University College Dublin Dublin Ireland
Service of Cardiology and Internal Medicine Mater Olbia Hospital Olbia Italy
Turku PET Centre Turku University Hospital and University of Turku Turku Finland
References provided by Crossref.org
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