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Published on: March 15, 2022
Comparative Analysis of Cardiac CT and Invasive Coronary Angiography for Suspected Stable Coronary Artery Disease and
Jonathan D Dodd1,2, Maria Bosserdt3, Anna Oleksiak4
1Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6FA, Ireland.
Insights
A CT-first strategy for stable chest pain increased functional testing and reduced revascularizations and complications compared to invasive coronary angiography-first. Outcomes were similar for angina rates after 3.5 years.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Medical Technology
Background:
- Stable chest pain with suspected coronary artery disease (CAD) requires effective diagnostic strategies.
- Invasive coronary angiography (ICA) is a standard diagnostic and therapeutic tool, but carries risks.
- CT coronary angiography (CTCA) offers a non-invasive alternative for evaluating coronary arteries.
Purpose of the Study:
- To compare functional testing and management outcomes between CTCA-first and ICA-first strategies.
- To assess the impact of strategy on revascularization, complications, and angina in patients with stable chest pain and low-to-intermediate CAD probability.
Main Methods:
- Secondary analysis of the prospective, multicenter DISCHARGE trial (NCT02400229).
- Randomized comparison of CTCA-first versus ICA-first strategies in 3414 participants.
- Outcomes assessed over 3.5 years included functional testing rates, revascularization, major complications, and angina, stratified by CAD severity.
Main Results:
- CTCA-first led to significantly more functional testing for obstructive CAD without high-risk anatomy (53.3% vs 24.3%).
- Revascularizations were lower with CTCA-first in both obstructive CAD with high-risk anatomy (58.2% vs 82.1%) and without high-risk anatomy (37.9% vs 59.6%).
- CTCA-first resulted in fewer major complications and similar rates of angina compared to ICA-first.
Conclusions:
- A CTCA-first strategy increases functional testing and reduces revascularizations and major complications in stable chest pain patients.
- The benefits of CTCA-first are influenced by coronary artery disease severity.
- CTCA-first demonstrates comparable angina rates to ICA-first over a 3.5-year follow-up.
Abstract:
Purpose To compare functional testing and management after cardiac CT-first versus invasive coronary angiography (ICA)-first strategies in participants with stable chest pain and low to intermediate probability of obstructive coronary artery disease (CAD) initially referred for ICA. Materials and Methods This study was a prespecified secondary analysis of the prospective, multicenter, randomized DISCHARGE (Diagnostic Imaging Strategies for Participants with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease) trial (ClinicalTrials.gov no. NCT02400229) conducted between October 2015 and April 2019. The primary outcome was functional testing rates at each of the study sites after first test; secondary outcomes included revascularization, major postprocedure complications, and angina after a 3.5-year follow-up, all stratified by CAD severity. Comparisons were performed using adjusted multiple regression. Results Of 3561 participants (mean age, 60.1 years ± 10.1 [SD]; 2002 [56.2%] female), 3414 were included in the final analysis. CT-first resulted in more functional testing for obstructive CAD without high-risk anatomy as compared with ICA-first (114 of 214 [53.3%] vs 62 of 255 [24.3%]; adjusted odds ratio [OR], 3.55; 95% CI: 2.40, 5.28; Pinteraction < .001). Revascularizations were lower for CT-first in obstructive CAD with high-risk anatomy (146 of 251 [58.2%] vs 161 of 196 [82.1%]; adjusted OR, 0.3; 95% CI: 0.19, 0.47) and without high-risk anatomy (81 of 214 [37.9%] vs 152 of 255 [59.6%]; adjusted OR, 0.41; 95% CI: 0.28, 0.60). ICA-first had more major complications with high-risk anatomy (11 of 196 [5.6%] vs five of 251 [2.0%]) and non-high-risk anatomy (11 of 255 [4.3%] vs two of 214 [0.9%]) than CT-first. Angina rates were similar (38 of 465 [8.2%] vs 32 of 451 [7.1%]; adjusted OR, 1.13; 95% CI: 0.69, 1.86). Conclusion A CT-first strategy increased functional testing, was influenced by CAD severity, and reduced revascularizations and major complications with similar angina rates after a 3.5-year follow-up compared with an ICA-first strategy in participants with stable chest pain. Keywords: CT Coronary Angiography, Coronary Arteries, Percutaneous, MR Perfusion, Cardiac, Heart, Comparative Studies Clinical trial registration no. NCT02400229 Supplemental material is available for this article. © RSNA, 2025.
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