IMPORTANCE: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown. OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina. DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024. INTERVENTIONS: Random assignment to CT or ICA. MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated. RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007). CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences. 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

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 United Kingdom

Department of Cardiology Alb Fils Kliniken Göppingen Germany

Department of Cardiology Amager Hvidovre Hospital University of Copenhagen Copenhagen Denmark

Department of Cardiology Angiology and Intensive Care Medicine Deutsches Herzzentrum der Charité Campus Charité Mitte 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 Rigshospitalet Copenhagen 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 FT 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 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 United Kingdom

Department of Cardiology University of Leipzig Heart Centre Leipzig Germany

Department of Clinical Epidemiology and Applied Biostatistics Universitätsklinikum Tübingen Tübingen Germany

Department of Clinical Medicine Faculty of Health and Medical Sciences 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 Medical Surgical Sciences and Translational Medicine Sapienza University of Rome Rome Italy

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

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

Department of Radiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Radiology Innsbruck Medical University Innsbruck Austria

Department of Radiology Medical Imaging Center Semmelweis University Budapest Hungary

Department of Radiology St Vincent's University Hospital Dublin Ireland

Department of Radiology University of Cagliari Cagliari Italy

Deutsches Herzzentrum der Charité Berlin Germany

Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina

DZHK partner site Berlin Germany

ECRIN ERIC Paris France

Edge Hill University Ormskirk 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

Institute for Cardiovascular Medicine and Science Faculty of Health and Life Sciences University of Liverpool Liverpool United Kingdom

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

National Institute of Cardiology Warsaw Poland

Policlinico Umberto 1 Department of Clinical Internal Anesthesiological and Cardiovascular Sciences Sapienza University of Rome

School of Cardiovascular and Metabolic Health University of Glasgow Glasgow United Kingdom

School of Medicine University College Dublin Dublin Ireland

Turku PET Centre Turku University Hospital and University of Turku Turku Finland

University of Latvia Riga Latvia

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ClinicalTrials.gov
NCT02400229