Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease-Reference-Cited by-同舟云学术

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

Published:2023-09-19 Issue:11 Volume:46 Page:2015-2023
ISSN:0149-5992
Container-title:Diabetes Care
language:en
Short-container-title:

Author:

Benedek Theodora¹²,Wieske Viktoria³,Szilveszter Bálint⁴,Kofoed Klaus F.⁵⁶,Donnelly Patrick⁷,Rodriguez-Palomares José⁸⁹,Erglis Andrejs¹⁰,Veselka Josef¹¹,Šakalytė Gintarė¹²,Ađić Nada Čemerlić¹³¹⁴,Gutberlet Matthias¹⁵,Diez Ignacio¹⁶,Davis Gershan¹⁷¹⁸,Zimmermann Elke²,Kępka Cezary¹⁹,Vidakovic Radosav²⁰²¹,Francone Marco²²²³,Ilnicka-Suckiel Małgorzata²⁴,Plank Fabian²⁵,Knuuti Juhani²⁶,Faria Rita²⁷,Schröder Stephen²⁸,Berry Colin²⁹³⁰,Saba Luca³¹,Ruzsics Balazs³²³³,Rieckmann Nina³⁴,Kubiak Christine³⁵,Schultz Hansen Kristian³⁶,Müller-Nordhorn Jacqueline³⁷,Merkely Bela⁴,Sigvardsen Per E.⁵⁶,Benedek Imre³⁸,Orr Clare⁷,Valente Filipa Xavier⁸⁹,Zvaigzne Ligita¹⁰,Horváth Martin¹¹,Jankauskas Antanas¹²,Ađić Filip¹³¹⁴,Woinke Michael¹⁵,Mulvihill Niall³⁹⁴⁰,Lecumberri Iñigo¹⁶,Thwaite Erica¹⁷¹⁸,Laule Michael⁴¹,Kruk Mariusz¹⁹,Stefanovic Milica²⁰,Mancone Massimo²²²³,Kuśmierz Donata⁴²,Feuchtner Gudrun⁴³,Pietilä Mikko²⁶⁴⁴,Ribeiro Vasco Gama²⁷,Drosch Tanja²⁸,Delles Christian²⁹,Melis Marco²²,Fisher Michael³²³³⁴⁵,Boussoussou Melinda⁴,Kragelund Charlotte⁵,Aurelian Rosca⁴⁶,Kelly Stephanie⁷,Garcia del Blanco Bruno⁸⁹,Rubio Ainhoa¹⁶,Károlyi Mihály⁴,Hove Jens D.⁴⁷⁴⁸,Rodean Ioana³⁸,Regan Susan⁷,Calabria Hug Cuéllar⁴⁹,Gellér László⁴,Larsen Linnea⁵⁰,Hodas Roxana¹,Napp Adriane E.³,Haase Robert³,Feger Sarah³,Mohamed Mahmoud³,Serna-Higuita Lina M.⁵¹,Neumann Konrad⁵²,Dreger Henryk⁴¹⁵³,Rief Matthias³,Danesh John⁵⁴,Estrella Melanie³,Bosserdt Maria³,Martus Peter⁵¹,Dodd Jonathan D.⁴⁰⁵⁵^ORCID,Dewey Marc³⁵³⁵⁶⁵⁷⁵⁸

Affiliation:

1. 1Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania

2. 2County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania

3. 3Department of Radiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

4. 4Heart and Vascular Center, Semmelweis University, Budapest, Hungary

5. 5Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark

6. 6Department of Radiology, Copenhagen University Hospital–Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

7. 7Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, U.K.

8. 8Department of Cardiology, Hospital Universitario Vall d’Hebron, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain

9. 9Centro de Investigacion Biomedica en Red, CIBERCV, Madrid, Spain

10. 10Department of Cardiology, Paul Stradins Clinical University Hospital, University of Latvia, Riga, Latvia

11. 11Department of Cardiology, Motol University Hospital, Prague, Czech Republic

12. 12Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Cardiology Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania

13. 13Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia

14. 14Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia

15. 15Department of Radiology, University of Leipzig Heart Centre, Leipzig, Germany

16. 16Department of Cardiology, Basurto Hospital, Bilbao, Spain

17. 17Department of Cardiology, Aintree University Hospital, Liverpool, U.K.

18. 18Edge Hill University, Ormskirk, U.K.

19. 19National Institute of Cardiology, Warsaw, Poland

20. 20Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, Belgrade, Serbia

21. 21Faculty of Medicine, University of Belgrade, Belgrade, Serbia

22. 22Department of Radiological Sciences, Sapienza University of Rome, Italy

23. 23Department of Biomedical Sciences, Humanitas University, and IRCCS Humanitas Research Hospital, Milan, Italy

24. 24Department of Cardiology, Provincial Specialist Hospital in Wrocław, Wrocław, Poland

25. 25Department of Internal Medicine III, Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria

26. 26Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland

27. 27Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal

28. 28Department of Cardiology, Alb Fils Kliniken, Göppingen, Germany

29. 29School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, U.K.

30. 30Golden Jubilee National Hospital, Clydebank, U.K.

31. 31Department of Radiology, Azienda Ospedaliero Universitaria, Cagliari, Italy

32. 32Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K.

33. 33Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, U.K.

34. 34Institute of Public Health, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

35. 35European Clinical Research Infrastructure Network-European Research Infrastructure Consortium, Paris, France

36. 36Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark

37. 37Bavarian Cancer Registry, Bavarian Health and Food Safety Authority, Munich, Germany

38. 38Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania

39. 39Department of Cardiology, St. Vincent’s University Hospital, Dublin, Ireland

40. 40School of Medicine, University College Dublin, Dublin, Ireland

41. 41Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Berlin, Germany

42. 42Department of Radiology, Provincial Specialist Hospital in Wrocław, Wrocław, Poland

43. 43Department of Radiology, Innsbruck Medical University, Innsbruck, Austria

44. 44Administrative Centre, Health Care District of Southwestern Finland, Turku, Finland

45. 45Faculty of Health and Life Sciences, University of Liverpool, Liverpool, U.K.

46. 46Department of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania

47. 47Department of Cardiology, Copenhagen University Hospital–Amager and Hvidovre, Hvidovre, Denmark

48. 48Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

49. 49Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

50. 50Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark

51. 51Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany

52. 52Institute of Biometry and Clinical Epidemiology, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

53. 53German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany

54. 54Department of Public Health and Primary Care at Cambridge University, Cambridge, U.K.

55. 55Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland

56. 56Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany

57. 57Berlin University Alliance, Berlin, Germany

58. 58Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany

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.

Funder

Rigshospitalet, University of Copenhagen

BIOQIC

FP7 Health

British Heart Foundation

Berlin Institute of Health

Deutsche Forschungsgemeinschaft

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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