Age and Computed Tomography and Invasive Coronary Angiography in Stable Chest Pain-Reference-Cited by-同舟云学术

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

Published:2024-04-01 Issue:4 Volume:9 Page:346
ISSN:2380-6583
Container-title:JAMA Cardiology
language:en
Short-container-title:JAMA Cardiol

Author:

,Bosserdt Maria¹,Serna-Higuita Lina M.²,Feuchtner Gudrun³,Merkely Bela⁴,Kofoed Klaus F.⁵,Benedek Theodora⁶⁷,Donnelly Patrick⁸,Rodriguez-Palomares José⁹¹⁰,Erglis Andrejs¹¹¹²,Štěchovský Cyril¹³,Šakalytė Gintarė¹⁴¹⁵,Ađić Nada Čemerlić¹⁶¹⁷,Gutberlet Matthias¹⁸,Dodd Jonathan D.¹⁹²⁰,Diez Ignacio²¹,Davis Gershan²²²³,Zimmermann Elke¹,Kępka Cezary²⁴,Vidakovic Radosav²⁵²⁶,Francone Marco²⁷²⁸,Ilnicka-Suckiel Małgorzata²⁹,Plank Fabian³³⁰,Knuuti Juhani³¹,Faria Rita³²,Schröder Stephen³³,Berry Colin³⁴³⁵,Saba Luca³⁶,Ruzsics Balazs³⁷³⁸,Rieckmann Nina³⁹,Kubiak Christine⁴⁰,Hansen Kristian Schultz⁴¹,Müller-Nordhorn Jacqueline⁴²,Szilveszter Bálint⁴,Sigvardsen Per E.⁵,Benedek Imre⁴³,Orr Clare⁸,Valente Filipa Xavier⁹¹⁰,Zvaigzne Ligita⁴⁴,Suchánek Vojtěch⁴⁵,Jankauskas Antanas⁴⁶,Ađić Filip¹⁶¹⁷,Woinke Michael⁴⁷,Hensey Mark⁴⁸,Lecumberri Iñigo⁴⁹,Thwaite Erica⁵⁰,Laule Michael⁵¹,Kruk Mariusz²⁴,Neskovic Aleksandar N.²⁵²⁶,Mancone Massimo⁵²,Kuśmierz Donata⁵³,Pietilä Mikko⁵⁴⁵⁵,Ribeiro Vasco Gama³²,Drosch Tanja³³,Delles Christian³⁴,Porcu Maurizio⁵⁶,Fisher Michael³⁷⁵⁷³⁸,Boussoussou Melinda⁴,Kragelund Charlotte⁵⁸,Aurelian Rosca⁵⁹,Kelly Stephanie⁸,Garcia del Blanco Bruno⁹,Rubio Ainhoa²¹,Maurovich-Horvat Pál⁴⁶⁰,Hove Jens D.⁶¹⁶²,Rodean Ioana⁴³,Regan Susan⁸,Cuellar-Calabria Hug⁶³,Molnár Levente⁴,Larsen Linnea⁶⁴,Hodas Roxana⁶,Napp Adriane E.¹,Haase Robert¹,Feger Sarah¹,Mohamed Mahmoud¹,Neumann Konrad³⁹,Dreger Henryk⁶⁵⁶⁶,Rief Matthias¹,Wieske Viktoria¹,Estrella Melanie¹,Martus Peter²,Sox Harold C.⁶⁷,Dewey Marc¹⁶⁶⁶⁸⁶⁹

Affiliation:

1. Department of Radiology, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt–Universität zu Berlin, Berlin, Germany

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

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

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

5. Department of Cardiology and Radiology, Copenhagen University Hospital—Rigshospitalet & Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

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

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

8. Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, United Kingdom

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

10. Centro de Investigacion Biomedica en Red, Madrid, Spain

11. University of Latvia, Riga, Latvia

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

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

14. Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

15. Department of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania

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

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

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

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

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

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

22. Department of Cardiology, Aintree University Hospital, Liverpool, United Kingdom

23. Edge Hill University, Ormskirk, United Kingdom

24. National Institute of Cardiology, Warsaw, Poland

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

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

27. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy

28. Department of Biomedical Sciences, Humanitas University, Milan, Italy

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

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

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

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

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

34. School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom

35. Golden Jubilee National Hospital, Clydebank, United Kingdom

36. Department of Radiology, University of Cagliari, Cagliari, Italy

37. Department of Cardiology, Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom

38. Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

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

40. ECRIN-ERIC (European Clinical Research Infrastructure Network–European Research Infrastructure Consortium), Paris, France

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

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

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

44. Department of Radiology, Paul Stradins Clinical University Hospital, Riga, Latvia

45. Department of Imaging Methods, Motol University Hospital, Prague, Czech Republic

46. Institute of Cardiology, Lithuanian University of Health Sciences, Department of Radiology, Kaunas Clinics, Kaunas, Lithuania

47. Department of Cardiology, University of Leipzig Heart Centre, Leipzig, Germany

48. Department of Cardiology, St Vincent’s University Hospital and School of Medicine, Dublin, Ireland

49. Department of Radiology, Basurto Hospital, Bilbao, Spain

50. Department of Radiology, Aintree University Hospital, Liverpool, United Kingdom

51. Department of Cardiology and Angiology, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany

52. Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

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

54. Heart Center, Turku University Hospital and University of Turku, Turku, Finland

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

56. Service of Cardiology and Internal Medicine, Mater Olbia Hospital, Olbia, Italy

57. Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom

58. Department of Cardiology, Nordsjaellands Hospital, University of Copenhagen, Hilleroed, Denmark

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

60. Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary

61. Department of Cardiology, Copenhagen University Hospital—Amager and Hvidovre, Hvidovre, Denmark

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

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

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

65. Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow-Klinikum, Berlin, Germany

66. Deutsches Herzzentrum der Charité, Berlin, Germany

67. Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

68. DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany

69. Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany

Abstract

ImportanceThe effectiveness and safety of computed tomography (CT) and invasive coronary angiography (ICA) in different age groups is unknown.ObjectiveTo determine the association of age with outcomes of CT and ICA in patients with stable chest pain.Design, Setting, and ParticipantsThe 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.InterventionsPatients were randomly assigned to a CT-first strategy or a direct-to-ICA strategy.Main Outcomes and MeasuresMACE (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.ResultsAmong 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 RelevanceAge 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 RegistrationClinicalTrials.gov Identifier: NCT02400229

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamacardiology/articlepdf/2815696/jamacardiology_bosserdt_2024_oi_240001_1711658465.23311.pdf

Reference34 articles.

1. Diagnosis of obstructive coronary artery disease using computed tomography angiography in patients with stable chest pain depending on clinical probability and in clinically important subgroups: meta-analysis of individual patient data.;Haase;BMJ,2019

2. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes.;Knuuti;Eur Heart J,2020

3. Evaluation of computed tomography in patients with atypical angina or chest pain clinically referred for invasive coronary angiography: randomised controlled trial.;Dewey;BMJ,2016

4. Selective referral using CCTA vs direct referral for individuals referred to invasive coronary angiography for suspected CAD: a randomized, controlled, open-label trial.;Chang;JACC Cardiovasc Imaging,2019

5. The PROMISE trial: an inside perspective.;Hoffmann;J Cardiovasc Comput Tomogr,2015

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