Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease - UTU Research Portal

A1 Refereed original research article in a scientific journal

Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

Authors: Benedek T, Wieske V, Szilveszter B, Kofoed KF, Donnelly P, Rodriguez-Palomares J, Erglis A, Veselka J, Šakalytė G, Ađić NČ, Gutberlet M, Diez I, Davis G, Zimmermann E, Kępka C, Vidakovic R, Francone M, Ilnicka-Suckiel M, Plank F, Knuuti J, Faria R, Schröder S, Berry C, Saba L, Ruzsics B, Rieckmann N, Kubiak C, Schultz Hansen K, Müller-Nordhorn J, Merkely B, Sigvardsen PE, Benedek I, Orr C, Valente FX, Zvaigzne L, Horváth M, Jankauskas A, Ađić F, Woinke M, Mulvihill N, Lecumberri I, Thwaite E, Laule M, Kruk M, Stefanovic M, Mancone M, Kuśmierz D, Feuchtner G, Pietilä M, Ribeiro VG, Drosch T, Delles C, Melis M, Fisher M, Boussoussou M, Kragelund C, Aurelian R, Kelly S, Garcia Del Blanco B, Rubio A, Károlyi M, Hove JD, Rodean I, Regan S, Calabria HC, Gellér L, Larsen L, Hodas R, Napp AE, Haase R, Feger S, Mohamed M, Serna-Higuita LM, Neumann K, Dreger H, Rief M, Danesh J, Estrella M, Bosserdt M, Martus P, Dodd JD, Dewey M

Publisher: American Diabetes Association

Publication year: 2023

Journal: Diabetes Care

Journal name in source: Diabetes care

Journal acronym: Diabetes Care

Volume: 46

Issue: 11

First page : 2015

Last page: 2023

ISSN: 0149-5992

eISSN: 1935-5548

DOI: https://doi.org/10.2337/dc23-0710

Web address : https://doi.org/10.2337/dc23-0710

Abstract

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.