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CT as effective as invasive angiography for guiding treatment of stable chest pain

The New England Journal of Medicine
Reuters Health - 04/03/2022 - Patients with coronary-artery disease (CAD) do just as well when their treatment is guided by computed tomography as they do with invasive coronary angiography, and with fewer procedure-related complications, according to findings from the DISCHARGE trial.

The study, conducted at 26 European centers and published in the New England Journal of Medicine, included 3,561 volunteers with stable chest pain and an intermediate pretest probability of obstructive CAD.

Over 3.5 years, 2.1% of the people whose care was guided by CT suffered a heart attack, stroke or died from a cardiovascular cause. The rate was 3.0% with invasive angiography (P=0.10).

When the study team looked at major procedure-related complications, the respective rates were 0.5% and 1.9%, a significant 74% reduction.

The researchers found a 17% increase in angina among the CT-treated patients but the difference wasn't statistically significant. Rates were 8.8% for angina during the first four weeks of follow-up versus 7.5% with invasive angiography, where the 95% confidence interval was 0.92 to 1.48).

The findings were also reported Friday at a meeting of the European Congress of Radiology.

Chief author Dr. Marc Dewey of Charite University Medicine Berlin did not respond to emailed questions.

In a linked editorial, Dr. Joseph Loscalzo of Brigham and Women's Hospital in Boston raises questions about the study, including whether the results might be tempered by the fact that only about a quarter of the patients in each group had obstructive coronary-artery disease, "which suggests that the overall trial population had a low risk of obstructive CAD rather than an intermediate risk."

He noted that over the past ten years coronary computed tomographic angiography "has become the preferred imaging approach for the assessment of patients with stable chest pain, especially in those with an intermediate pretest probability of obstructive CAD."

SOURCES: https://bit.ly/3KbFNSl and https://bit.ly/35MwrNS The New England Journal of Medicine, online March 4, 2022.

By Reuters Staff

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