TY - JOUR

T1 - Computed tomography versus invasive coronary angiography

T2 - design and methods of the pragmatic randomised multicentre DISCHARGE trial

AU - Napp, Adriane E.

AU - Haase, Robert

AU - Laule, Michael

AU - Schuetz, Georg M.

AU - Rief, Matthias

AU - Dreger, Henryk

AU - Feuchtner, Gudrun

AU - Friedrich, Guy

AU - Špaček, Miloslav

AU - Suchánek, Vojtěch

AU - Fuglsang Kofoed, Klaus

AU - Engstrøm, Thomas

AU - Schroeder, Stephen

AU - Drosch, Tanja

AU - Gutberlet, Matthias

AU - Woinke, Michael

AU - Maurovich-Horvat, Pál

AU - Merkely, Bela

AU - Donnelly, Patrick

AU - Ball, Peter

AU - Dodd, Jonathan D.

AU - Quinn, Martin

AU - Saba, Luca

AU - Porcu, Maurizio

AU - Francone, Marco

AU - Mancone, Massimo

AU - Erglis, Andrejs

AU - Zvaigzne, Ligita

AU - Jankauskas, Antanas

AU - Sakalyte, Gintare

AU - Harań, Tomasz

AU - Ilnicka-Suckiel, Malgorzata

AU - Bettencourt, Nuno

AU - Gama-Ribeiro, Vasco

AU - Condrea, Sebastian

AU - Benedek, Imre

AU - Čemerlić Adjić, Nada

AU - Adjić, Oto

AU - Rodriguez-Palomares, José

AU - Garcia Del Blanco, Bruno

AU - Roditi, Giles

AU - Berry, Colin

AU - Davis, Gershan

AU - Thwaite, Erica

AU - Knuuti, Juhani

AU - Pietilä, Mikko

AU - Kępka, Cezary

AU - Kruk, Mariusz

AU - Vidakovic, Radosav

AU - Neskovic, Aleksandar N

AU - Díez, Ignacio

AU - Lecumberri, Iñigo

AU - Geleijns, Jacob

AU - Kubiak, Christine

AU - Strenge-Hesse, Anke

AU - Do, The Hoang

AU - Frömel, Felix

AU - Gutiérrez-Ibarluzea, Iñaki

AU - Benguria-Arrate, Gaizka

AU - Keiding, Hans

AU - Katzer, Christoph

AU - Müller-Nordhorn, Jacqueline

AU - Rieckmann, Nina

AU - Walther, Mario

AU - Schlattmann, Peter

AU - Dewey, Marc

AU - The Discharge Trial Group, Discharge Trial Group

PY - 2017/6

Y1 - 2017/6

N2 - Objectives: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). Methods: In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Results: Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. Conclusions: The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. Key Points: • Coronary artery disease (CAD) is a major cause of morbidity and mortality.• Invasive coronary angiography (ICA) is the reference standard for detection of CAD.• Noninvasive computed tomography angiography excludes CAD with high sensitivity.• CT may effectively reduce the approximately 2 million negative ICAs in Europe.• DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

AB - Objectives: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). Methods: In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. Results: Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. Conclusions: The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. Key Points: • Coronary artery disease (CAD) is a major cause of morbidity and mortality.• Invasive coronary angiography (ICA) is the reference standard for detection of CAD.• Noninvasive computed tomography angiography excludes CAD with high sensitivity.• CT may effectively reduce the approximately 2 million negative ICAs in Europe.• DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

KW - Adverse events

KW - Angiography

KW - Comparative effectiveness

KW - Computed tomography

KW - Invasive coronary angiography

U2 - 10.1007/s00330-016-4620-z

DO - 10.1007/s00330-016-4620-z

M3 - Journal article

C2 - 27864607

AN - SCOPUS:84995812356

VL - 27

SP - 2957

EP - 2968

JO - European Radiology

JF - European Radiology

SN - 0938-7994

ER -