BACKGROUND: Current therapy for in-stent restenosis (ISR) is based on drug-eluting stents (DES) or drug-eluting balloon catheters. This prospective randomized study compared the efficacy of a novel sirolimus-eluting balloon (SEB) catheter to that of a paclitaxel-eluting balloon (PEB) catheter for the treatment of bare-metal stent (BMS-ISR) or DES-ISR. METHODS: A total of 145 patients with 158 BMS or DES-ISR lesions were randomly assigned to the treatment with either SEB or PEB. The in-segment late lumen loss at 12 months, the 12-month incidence of binary ISR, and major adverse cardiac events (cardiac death, nonfatal acute myocardial infarction, or target lesion revascularization) were compared between groups. RESULTS: The noninferiority of SEB compared with PEB in the treatment of BMS/DES-ISR with respect to late lumen loss was not demonstrated (Δlate lumen loss, -0.024 mm [95% CI, -0.277 to 0.229]; for a noninferiority margin of 0.20 mm), except in the post hoc subanalysis for the BMS-ISR group (-0.203 mm [95% CI, -0.584 to 0.178]). No significant differences in the incidence of repeated binary ISR (31.6% versus 30.4%, P=0.906) or 12-month major adverse cardiac events (31% for both; P>0.999) between the SEB and PEB groups were observed. CONCLUSIONS: The noninferiority of SEB relative to PEB in the treatment of BMS/DES-ISR with respect to late lumen loss was not confirmed. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03667313.

• MeSH
• balónková koronární angioplastika * škodlivé účinky   přístrojové vybavení   MeSH
• biokompatibilní potahované materiály * aplikace a dávkování   MeSH
• časové faktory MeSH
• kardiovaskulární látky aplikace a dávkování   škodlivé účinky   MeSH
• koronární angioplastika * škodlivé účinky   přístrojové vybavení   MeSH
• koronární restenóza * diagnostické zobrazování   terapie   mortalita   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   terapie   mortalita   MeSH
• paclitaxel * aplikace a dávkování   škodlivé účinky   MeSH
• prospektivní studie MeSH
• protézy - design MeSH
• rizikové faktory MeSH
• senioři MeSH
• sirolimus * aplikace a dávkování   škodlivé účinky   MeSH
• srdeční katétry MeSH
• stenty uvolňující léky škodlivé účinky   MeSH
• stenty škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnocení ekvivalence MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

• MeSH
• jednofotonová emisní výpočetní tomografie metody   MeSH
• kadmium MeSH
• koronární cirkulace fyziologie   MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• prognóza MeSH
• telur MeSH
• zobrazování myokardiální perfuze * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH

OBJECTIVES: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. MATERIALS AND METHODS: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). RESULTS: Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. CONCLUSION: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. CLINICAL RELEVANCE STATEMENT: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. TRIAL REGISTRATION: ClinicalTrials.gov NCT02400229. KEY POINTS: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.

• MeSH
• koronární angiografie * metody   MeSH
• kouření * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   komplikace   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• propuštění pacienta MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pragmatická klinická studie MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: The clinical impact of a chronic total occlusion (CTO) in patients with 3-vessel coronary artery disease undergoing fractional flow reserve-guided percutaneous coronary intervention (PCI) with current-generation drug-eluting stents or coronary artery bypass grafting (CABG) is unclear. METHODS: The FAME 3 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) compared fractional flow reserve-guided PCI with CABG in patients with 3-vessel coronary artery disease. The primary end point was major adverse cardiac and cerebrovascular events, a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. In this substudy, the 3-year outcomes were analyzed in patients with or without a CTO. RESULTS: Of the patients randomized to PCI or CABG in the FAME 3 trial, 305 (21%) had a CTO. In the PCI arm, revascularization of the CTO was attempted in 61% with a procedural success rate of 88%. The incidence of major adverse cardiac and cerebrovascular events at 3 years was not significantly different between those with or without a CTO in both the PCI (15.2% versus 20.1%; adjusted hazard ratio, 0.62 [95% CI, 0.38-1.03]; P=0.07) and the CABG (13.0% versus 12.9%; adjusted hazard ratio, 0.96 [95% CI, 0.55-1.66]; P=0.88) arms. In those without a CTO, PCI was associated with a significantly higher risk of major adverse cardiac and cerebrovascular events compared with CABG (adjusted hazard ratio, 1.61 [95% CI, 1.20-2.17]; P<0.01) but not in those with a CTO (adjusted hazard ratio, 1.21 [95% CI, 0.64-2.28]; P=0.56; Pinteraction=0.31). CONCLUSIONS: The presence of a CTO did not significantly impact the treatment effect of PCI versus CABG at 3 years in patients with 3-vessel coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02100722.

• MeSH
• časové faktory MeSH
• chronická nemoc MeSH
• frakční průtoková rezerva myokardu * MeSH
• koronární angiografie * MeSH
• koronární angioplastika * škodlivé účinky   mortalita   MeSH
• koronární bypass * škodlivé účinky   mortalita   MeSH
• koronární okluze * diagnostické zobrazování   mortalita   terapie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen terapie   mortalita   diagnostické zobrazování   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenty uvolňující léky * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

BACKGROUND: Whether ticagrelor may reduce periprocedural myocardial necrosis after elective percutaneous coronary intervention (PCI) in patients with and without chronic clopidogrel therapy is unclear. OBJECTIVES: This study sought to compare ticagrelor vs clopidogrel in patients with and without chronic clopidogrel therapy before undergoing elective PCI. METHODS: In this prespecified analysis of the ALPHEUS (Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting) trial, patients were defined as clopidogrel(+) and clopidogrel(-) according to the presence and absence of clopidogrel treatment for ≥7 days before PCI, respectively. The primary endpoint was the composite of PCI-related myocardial infarction and major injury as defined by the third and fourth universal definition 48 hours after PCI. RESULTS: A total of 1,882 patients were included, 805 (42.7%) of whom were clopidogrel(+). These patients were older, had more comorbidities, and had more frequent features of complex PCI. The primary endpoint was less frequently present in clopidogrel(-) compared to clopidogrel(+) patients (32.8% vs 40.0%; OR: 0.73; 95% CI: 0.60-0.88), but no significant differences were reported for the risk of death, myocardial infarction, stroke, or transient ischemic attack at 48 hours or 30 days. Ticagrelor did not reduce periprocedural myocardial necrosis or the risk of adverse outcomes, and there was no significant interaction regarding the presence of chronic clopidogrel treatment. CONCLUSIONS: Clopidogrel-naive patients presented less periprocedural complications compared to clopidogrel(+) patients, a difference related to a lower risk profile and less complex PCI. The absence of clopidogrel at baseline did not affect the absence of a difference between ticagrelor and clopidogrel in terms of PCI-related complications supporting the use of clopidogrel as the standard of care in elective PCI in patients with or without chronic clopidogrel treatment.

• MeSH
• antagonisté purinergních receptorů P2Y škodlivé účinky   terapeutické užití   MeSH
• časové faktory MeSH
• chronická nemoc MeSH
• hodnocení rizik MeSH
• infarkt myokardu * mortalita   MeSH
• inhibitory agregace trombocytů * škodlivé účinky   terapeutické užití   MeSH
• klopidogrel * škodlivé účinky   terapeutické užití   aplikace a dávkování   MeSH
• koronární angioplastika * škodlivé účinky   mortalita   MeSH
• krvácení chemicky indukované   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nekróza MeSH
• nemoci koronárních tepen terapie   mortalita   diagnostické zobrazování   farmakoterapie   MeSH
• rizikové faktory MeSH
• senioři MeSH
• stenty MeSH
• ticagrelor * škodlivé účinky   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

Background Coronary artery calcium (CAC) has prognostic value for major adverse cardiovascular events (MACE) in asymptomatic individuals, whereas its role in symptomatic patients is less clear. Purpose To assess the prognostic value of CAC scoring for MACE in participants with stable chest pain initially referred for invasive coronary angiography (ICA). Materials and Methods This prespecified subgroup analysis from the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial, conducted between October 2015 and April 2019 across 26 centers in 16 countries, focused on adult patients with stable chest pain referred for ICA. Participants were randomly assigned to undergo either ICA or coronary CT. CAC scores from noncontrast CT scans were categorized into low, intermediate, and high groups based on scores of 0, 1-399, and 400 or higher, respectively. The end point of the study was the occurrence of MACE (myocardial infarction, stroke, and cardiovascular death) over a median 3.5-year follow-up, analyzed using Cox proportional hazard regression tests. Results The study involved 1749 participants (mean age, 60 years ± 10 [SD]; 992 female). The prevalence of obstructive coronary artery disease (CAD) at CT angiography rose from 4.1% (95% CI: 2.8, 5.8) in the CAC score 0 group to 76.1% (95% CI: 70.3, 81.2) in the CAC score 400 or higher group. Revascularization rates increased from 1.7% to 46.2% across the same groups (P < .001). The CAC score 0 group had a lower MACE risk (0.5%; HR, 0.08 [95% CI: 0.02, 0.30]; P < .001), as did the 1-399 CAC score group (1.9%; HR, 0.27 [95% CI: 0.13, 0.59]; P = .001), compared with the 400 or higher CAC score group (6.8%). No significant difference in MACE between sexes was observed (P = .68). Conclusion In participants with stable chest pain initially referred for ICA, a CAC score of 0 showed very low risk of MACE, and higher CAC scores showed increasing risk of obstructive CAD, revascularization, and MACE at follow-up. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Hanneman and Gulsin in this issue.

• MeSH
• bolesti na hrudi diagnostické zobrazování   MeSH
• dospělí MeSH
• infarkt myokardu * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• vápník MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%-60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m2, respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m2 exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. Clinical trial registration no. NCT02400229 © RSNA, 2024 Supplemental material is available for this article.

• MeSH
• bolesti na hrudi diagnostické zobrazování   MeSH
• dospělí MeSH
• index tělesné hmotnosti MeSH
• koronární angiografie MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• propuštění pacienta MeSH
• prospektivní studie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie 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.

• MeSH
• bolesti na hrudi etiologie   diagnóza   MeSH
• koronární angiografie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * komplikace   diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Kontext: Koronarografické vyšetření má pro řádné vyhodnocení lézí na koronárních tepnách jisté limitace. Použití intravaskulárního ultrazvuku (intravascular ultrasound, IVUS) před perkutánní koronární intervencí (PCI) může odhalit významné stenózy, pomáhá zvolit vhodný stent a může upozornit na možné komplikace. Cílem studie bylo hodnotit důsledky použití IVUS na klinické a angiograficky potvrzené výsledky revaskularizace nechráněného kmene levé věnčité tepny (unprotected left main, ULM) nebo proximální levé přední sestupné větve (left anterior descending, LAD) pomocí stentu při ischemické chorobě srdeční (ICHS). Materiály a metody: Byla provedena prospektivní randomizovaná kontrolovaná studie s 60 pacienty se stabilní anginou pectoris nebo s akutním koronárním syndromem bez elevací úseku ST. Koronarografické vyšetření provedené na katetrizačním pracovišti egyptského Národního ústavu zdraví odhalilo významné ischemické postižení kmene levé věnčité tepny nebo proximální LAD. U pacientů byla indikována revaskularizace formou PCI. Perkutánní koronární intervence navigovaná koronárním IVUS byla provedena u 30 pa- cientů (skupina A), zatímco ve skupině B nebyl při PCI koronární IVUS použit. Účastníci studie byli sledováni po dobu šesti měsíců s cílem analyzovat primární nebo sekundární sledované parametry. Výsledky: Navigace pomocí IVUS byla spojena se statisticky významně větším minimálním průsvitem cév po implantaci stentu potvrzeným kvantitativní koronarografií (quantitative coronary angiography, QCA) (p = 0,001), větším průměrem stentu (p = 0,001) a další dilatací (p = 0,02). Srovnání obou skupin prokázalo, že navigace pomocí IVUS byla spojena se statisticky významně nižším výskytem trombózy stentu v cílových lézích, nefatálního infarktu myokardu ve vztahu k počtu cílových lézí, s nižšími počty revaskularizačních výkonů na cílových lézích i s nižšími celkovými počty závažných nežádoucích srdečních příhod (major adverse cardiac events, MACE) během šestiměsíčního sledování (p = 0,038 pro všechny uvedené parametry). Závěry: Provádění PCI s implantací stentu do ULM a proximální LAD, navigované pomocí IVUS, zlepšuje klinický výsledný stav se statisticky významně nižším výskytem MACE do 6 měsíců díky významně nižšímu riziku revaskularizace cílové léze a trombózy stentu. U pacientů s ischemickým postižením ULM nebo proximální LAD doporučujeme rutinní používání navigace pomocí IVUS při revaskularizaci implantací stentu.

Background: Coronary angiography has some limitations in the proper assessment of coronary artery le- sions. Intravascular ultrasound (IVUS) before percutaneous coronary intervention (PCI) can identify significant stenosis, select the appropriate stent and detect complications. The study aimed to evaluate the impact of intravascular ultrasound on clinical and angiographic outcomes after revascularization by stenting for patients with unprotected left main (ULM) or proximal left anterior descending (LAD) coronary artery disease (CAD). Materials and methods: A prospective randomized controlled study that was carried on sixty patients presented with stable angina or non-ST elevation acute coronary syndrome. Coronary angiography that was carried out at cardiac catheterization laboratory at the National Heart Institute in Egypt revealed significant left main or proximal LAD coronary artery disease. Patients were scheduled for revascularization by PCI. Percutaneous coronary intervention guided by coronary IVUS was done in thirty patients (Group A). Whe- reas, Group B included 30 patients in which PCI was not guided by IVUS. The patients were followed for six months to detect any primary or secondary endpoints. Results: IVUS guidance was associated with a significant higher post-stent minimal lumen diameter as found by quantitative coronary angiography (QCA) (p = 0.001), stent diameter (p = 0.001), and adjunct post-dilatation (p = 0.02). By comparing both study groups it was found that IVUS guidance was associated with significant lower rates of stent thrombosis in target lesions, non-fatal myocardial infarction related to target lesions, target lesion revascularization and all cause major adverse cardiac events (MACE) within 6 months of follow-up (p-value 0.038, for all). Conclusions: IVUS guided PCI during ULM and proximal LAD coronary artery stenting improves clinical out- come with significant lower rates of MACE at 6 months which is due to significant lower risk of target lesion revascularization and stent thrombosis. We recommended routine use of IVUS during revascularization by stenting in cases of ULM or proximal LAD CAD.

• MeSH
• intervenční ultrasonografie * metody   přístrojové vybavení   MeSH
• koronární angioplastika metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   terapie   MeSH
• prospektivní studie MeSH
• randomizované kontrolované studie jako téma MeSH
• senioři MeSH
• statistika jako téma MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Geografické názvy
• Egypt MeSH

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.

• MeSH
• bolesti na hrudi MeSH
• CT angiografie MeSH
• diabetes mellitus * epidemiologie   MeSH
• koronární angiografie metody   MeSH
• lidé MeSH
• nemoci koronárních tepen * diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie MeSH
• prediktivní hodnota testů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH