Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial.
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DISCHARGE Trial Group, Rieckmann Nina, Neumann Konrad, Maurovich-Horvat Pál, Kofoed Klaus F, Benedek Theodora, Bosserdt Maria, Donnelly Patrick, Rodriguez-Palomares José, Erglis Andrejs, Štechovský Cyril, Šakalyte Gintare, Adic Nada Cemerlic, Gutberlet Matthias, Diez Ignacio, Davis Gershan, Zimmermann Elke, Kepka Cezary, Vidakovic Radosav, Francone Marco, Ilnicka-Suckiel Malgorzata, Plank Fabian, Knuuti Juhani, Faria Rita, Schröder Stephen, Berry Colin, Saba Luca, Ruzsics Balazs, Kubiak Christine, Hansen Kristian Schultz, Müller-Nordhorn Jacqueline, Merkely Bela, Knudsen Andreas D, Benedek Imre, Orr Clare, Valente Filipa Xavier, Zvaigzne Ligita, Suchánek Vojtech, Zajanckauskiene Laura, Adic Filip, Woinke Michael, Waters Darragh, Lecumberri Iñigo, Thwaite Erica, Laule Michael, Kruk Mariusz, Neskovic Aleksandar N, Birtolo Lucia Ilaria, Kusmierz Donata, Feuchtner Gudrun, Pietilä Mikko, Ribeiro Vasco Gama, Drosch Tanja, Delles Christian, Matta Gildo, Fisher Michael, Szilveszter Bálint, Larsen Linnea, Ratiu Mihaela, Kelly Stephanie, Garcia Del Blanco Bruno, Drobni Zsófia D, Jurlander Birgit, Regan Susan, Calabria Hug Cuéllar, Boussoussou Melinda, Engstrøm Thomas, Hodas Roxana, Napp Adriane E, Haase Robert, Feger Sarah, Mohamed Mahmoud M A, Dreger Henryk, Rief Matthias, Wieske Viktoria, Estrella Melanie, Michallek Florian, Mark Daniel B, Martus Peter, Dodd Jonathan D, Sox Harold C, Serna-Higuita Lina M, Dewey Marc
Аннотация
OBJECTIVE: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.
DESIGN, SETTING, AND PARTICIPANTS: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.
INTERVENTIONS: Random assignment to CT or ICA.
MAIN OUTCOMES AND MEASURES: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.
RESULTS: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).
CONCLUSIONS AND RELEVANCE: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02400229.