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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
Source :
Diabetes care [Diabetes Care] 2023 Nov 01; Vol. 46 (11), pp. 2015-2023.
Publication Year :
2023

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.<br />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).<br />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]).<br />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.<br /> (© 2023 by the American Diabetes Association.)

Details

Language :
English
ISSN :
1935-5548
Volume :
46
Issue :
11
Database :
MEDLINE
Journal :
Diabetes care
Publication Type :
Academic Journal
Accession number :
37725834
Full Text :
https://doi.org/10.2337/dc23-0710