Computed tomography to replace invasive coronary angiography? The DISCHARGE trial

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Strategies

Background:

• Coronary computed tomographic angiography (CTA) is advancing, challenging invasive coronary angiography (ICA) as the gold standard for coronary artery disease (CAD) evaluation.
• Stable chest pain patients with intermediate pre-test probability of obstructive CAD require effective diagnostic imaging strategies.

Purpose of the Study:

• To compare the effectiveness of ICA versus CTA as an initial diagnostic imaging strategy for patients with stable chest pain and intermediate pre-test probability of obstructive CAD.

Main Methods:

• The DISCHARGE Trial enrolled 3561 patients.
• Patients were evaluated for the primary composite outcome of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke over 3.5 years.

Main Results:

• No significant difference was observed between CTA and ICA in the primary composite outcome.
• CTA effectively rules out coronary artery disease, but cannot substitute for ICA when lesions are documented.

Conclusions:

• CTA and ICA demonstrate comparable effectiveness for initial diagnosis in selected CAD patients.
• Further clinical studies are needed to establish CTA's equivalence to ICA for guiding medical management.
• Advancements in CT technology may narrow the gap with invasive procedures in the future.