CT or Invasive Coronary Angiography in Stable Chest Pain

. 2022 Apr 28 ; 386 (17) : 1591-1602. [epub] 20220304

Jazyk angličtina Země Spojené státy americké Médium print-electronic

Typ dokumentu časopisecké články, multicentrická studie, pragmatická klinická studie, randomizované kontrolované studie

Perzistentní odkaz   https://www.medvik.cz/link/pmid35240010

Grantová podpora
Grant and Non-Financial Support Københavns Universitet
603266 FP7 Health
DE 1361/19-1 [428222922] and DE 1361/20-1 [4282231 Deutsche Forschungsgemeinschaft
Digital Health Accelerator Berlin Institute of Health
Centre of Research Excellence RE/18/6/34217 British Heart Foundation - United Kingdom

BACKGROUND: In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. METHODS: We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris. RESULTS: Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). CONCLUSIONS: Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy. (Funded by the European Union Seventh Framework Program and others; DISCHARGE ClinicalTrials.gov number, NCT02400229.).

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Komentář v

PubMed

Citace poskytuje Crossref.org

Zobrazit více v PubMed

ClinicalTrials.gov
NCT02400229

Najít záznam

Citační ukazatele

Možnosti archivace