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

Center of Advanced Research in Multimodality Cardiac Imaging CardioMed Medical Center Targu Mures Romania

Centro de Investigacion Biomedica en Red CIBERCV Madrid Spain

County Clinical Emergency Hospital Targu Mures Targu Mures Romania

Department of Biomedical Sciences Humanitas University and IRCCS Humanitas Research Hospital Milan Italy

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 George Emil Palade University of Medicine Pharmacy Science and Technology Targu Mures Romania

Department of Cardiology Herlev Gentofte Hospital Hellerup Denmark

Department of Cardiology Hospital of Lithuanian University of Health Sciences Kaunas Clinics Cardiology Institute Lithuanian University of Health Sciences Kaunas Lithuania

Department of Cardiology Hospital Universitario Vall d'Hebron Institut de Recerca Universitat Autònoma de Barcelona Barcelona Spain

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 Epidemiology and Applied Biostatistics Universitätsklinikum Tübingen Tübingen Germany

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Internal Medicine 3 Department of Cardiology Innsbruck Medical University Innsbruck Austria

Department of Internal Medicine Clinic of Cardiology George Emil Palade University of Medicine Pharmacy Science and Technology Targu Mures Romania

Department of Public Health and Primary Care at Cambridge University Cambridge U K

Department of Public Health Section for Health Services Research University of Copenhagen Copenhagen Denmark

Department of Radiological Sciences Sapienza University of Rome Italy

Department of Radiology Azienda Ospedaliero Universitaria Cagliari Italy

Department of Radiology Charité Universitätsmedizin Berlin Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

Department of Radiology Copenhagen University Hospital Rigshospitalet and Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Radiology Innsbruck Medical University Innsbruck Austria

Department of Radiology Institut de Diagnòstic per la Imatge Hospital Universitari Vall d'Hebron Institut de Recerca Vall d'Hebron Universitat Autònoma de Barcelona Barcelona Spain

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

Deutsches Herzzentrum der Charité Department of Cardiology Angiology and Intensive Care Medicine Campus Charité Mitte Berlin Germany

Edge Hill University Ormskirk U K

European Clinical Research Infrastructure Network European Research Infrastructure Consortium Paris France

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

Institute of Biometry and Clinical Epidemiology Charité Universitätsmedizin Berlin Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

Institute of Public Health Charité Universitätsmedizin Berlin Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

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

Erratum v

Diabetes Care. 2024 May 1;47(5):898. doi: 10.2337/dc24-er05a. PubMed

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