CT versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

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OBJECTIVES To compare cardiac CT with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain. RESEARCH DESIGN AND METHODS This was a prespecified analysis of the multicenter DISCHARGE trial (NCT02400229) in 16 European countries in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary endpoint was MACE (cardiovascular death, nonfatal myocardial infarction, or stroke) and the secondary endpoint 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, 557 (CT:263 vs. ICA:294) had diabetes and 2,984 (CT:1,536; ICA: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 endpoint occurred less frequently in the CT group than in the ICA group 3.8% [10/263] vs 8.2% [24/294], (HR: 0.45 [0.22-0.95]) as did the major procedure-related complication rate 0.4% [1/263] vs 2.7% [8/294], (HR: 0.30, [0.13 – 0.63]). CONCLUSIONS In patients with diabetes referred to 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.

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