CT as effective as angiography as first test for patients with diabetes, chest pain
Patients with diabetes and stable chest pain had no difference in major adverse cardiac events if they underwent cardiac CT first when they were referred for invasive coronary angiography, and they had fewer procedure-related complications with a CT-first strategy.
Cardiac CT as an initial test may be both effective and safer than invasive coronary angiography in patients with diabetes and stable chest pain, a study found.
To compare CT with angiography as the first strategy in patients with diabetes and stable chest pain, researchers conducted a prespecified analysis of the DISCHARGE trial. The trial, conducted in 16 European countries, had randomized patients who were referred for angiography to either undergo cardiac CT first or go straight to angiography. The primary end point was a major adverse cardiac event (MACE), defined as cardiovascular death, nonfatal myocardial infarction, or stroke, and the secondary end point added transient ischemic attacks and major procedure-related complications. Results were published Sept. 19 in Diabetes Care.
At a median of 3.5 years, follow-up data were available for 3,541 patients referred for the investigation of stable chest pain, of which 557 had diabetes and 2,984 did not. Overall, a CT-first strategy compared with an angiography-first strategy showed no difference in MACE. In patients with diabetes (263 who got CT, 294 who underwent angiography), the expanded MACE end point occurred less frequently in the CT group than in the angiography group (3.8% vs. 8.2%; hazard ratio [HR], 0.45 [95% CI, 0.22 to 0.95]), as did major procedure-related complications (0.4% vs. 2.7%; HR, 0.30 [95% CI, 0.13 to 0.63]).
Based on the results, making cardiac CT the primary imaging modality for the investigation of patients with diabetes and stable chest pain could be beneficial, according to the study authors.
“The results suggest that a CT-first strategy is noninferior to an [invasive coronary angiography]-first strategy in terms of MACE rates but may offer potential benefits in terms of reduced expanded MACE and major procedure-related complications,” they concluded.