TY - JOUR

T1 - Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain

T2 - A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

AU - Bosserdt, Maria

AU - Serna-Higuita, Lina M

AU - Feuchtner, Gudrun

AU - Merkely, Bela

AU - Kofoed, Klaus F

AU - Benedek, Theodora

AU - Donnelly, Patrick

AU - Rodriguez-Palomares, José

AU - Erglis, Andrejs

AU - Štechovský, Cyril

AU - Šakalyte, Gintare

AU - Adic, Nada Cemerlic

AU - Gutberlet, Matthias

AU - Dodd, Jonathan D

AU - Diez, Ignacio

AU - Davis, Gershan

AU - Zimmermann, Elke

AU - Kepka, Cezary

AU - Vidakovic, Radosav

AU - Francone, Marco

AU - Ilnicka-Suckiel, Malgorzata

AU - Plank, Fabian

AU - Knuuti, Juhani

AU - Faria, Rita

AU - Schröder, Stephen

AU - Berry, Colin

AU - Saba, Luca

AU - Ruzsics, Balazs

AU - Rieckmann, Nina

AU - Kubiak, Christine

AU - Hansen, Kristian Schultz

AU - Müller-Nordhorn, Jacqueline

AU - Szilveszter, Bálint

AU - Sigvardsen, Per E

AU - Benedek, Imre

AU - Orr, Clare

AU - Valente, Filipa Xavier

AU - Zvaigzne, Ligita

AU - Suchánek, Vojtech

AU - Jankauskas, Antanas

AU - Adic, Filip

AU - Woinke, Michael

AU - Hensey, Mark

AU - Lecumberri, Iñigo

AU - Thwaite, Erica

AU - Laule, Michael

AU - Kruk, Mariusz

AU - Kragelund, Charlotte

AU - Hove, Jens D

AU - Larsen, Linnea

AU - DISCHARGE Trial Group

PY - 2024

Y1 - 2024

N2 - 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.

AB - 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.

U2 - 10.1001/jamacardio.2024.0001

DO - 10.1001/jamacardio.2024.0001

M3 - Journal article

C2 - 38416472

VL - 9

SP - 346

EP - 356

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 4

ER -