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

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

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 and Angiology Charité Universitätsmedizin Berlin Freie Universität Berlin and Humboldt Universität zu Berlin Germany

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

Department of Cardiology Angiology and Intensive Care Medicine Campus Virchow Klinikum Berlin 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 Tirgu Mures Romania

Department of Cardiology Herlev Gentofte Hospital Hellerup Denmark

Department of Cardiology Hospital of 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 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 Epidemiology and Applied Biostatistics Universitätsklinikum Tübingen Tübingen Germany

Department of Clinical Internal Anesthesiologic and Cardiovascular Sciences Sapienza University of Rome Rome Italy

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Imaging Methods Motol University Hospital Prague Czech Republic

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 Section for Health Services Research University of Copenhagen Copenhagen Denmark

Department of Radiological Oncological and Pathological Sciences Sapienza University of Rome Rome Italy

Department of Radiology Aintree University Hospital Liverpool United Kingdom

Department of Radiology Basurto Hospital Bilbao Spain

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

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

ECRIN ERIC Paris France

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

Institute for Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital Liverpool United Kingdom

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

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

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

University of Latvia Riga Latvia

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ClinicalTrials.gov
NCT02400229