Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial

Adriane E. Napp, Robert Haase, Michael Laule, Georg M. Schuetz, Matthias Rief, Henryk Dreger, Gudrun Feuchtner, Guy Friedrich, Miloslav Špaček, Vojtěch Suchánek, Klaus Fuglsang Kofoed, Thomas Engstroem, Stephen Schroeder, Tanja Drosch, Matthias Gutberlet, Michael Woinke, Pál Maurovich-Horvat, Béla Merkely, Patrick Donnelly, Peter BallJonathan D. Dodd, Martin Quinn, Luca Saba, Maurizio Porcu, Marco Francone, Massimo Mancone, Andrejs Erglis, Ligita Zvaigzne, Antanas Jankauskas, Gintare Sakalyte, Tomasz Harań, Malgorzata Ilnicka-Suckiel, Nuno Bettencourt, Vasco Gama-Ribeiro, Sebastian Condrea, Imre Benedek, Nada Čemerlić Adjić, Oto Adjić, José Rodriguez-Palomares, Bruno Garcia del Blanco, Giles Roditi, Colin Berry, Gershan Davis, Erica Thwaite, Juhani Knuuti, Mikko Pietilä, Cezary Kępka, Mariusz Kruk, Radosav Vidakovic, Aleksandar N. Neskovic, The DISCHARGE Trial Group

Research output: Contribution to journalArticle (journal)peer-review

30 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2957-2968
Number of pages12
JournalEuropean Radiology
Volume27
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

Keywords

  • Adverse events
  • Angiography
  • Comparative effectiveness
  • Computed tomography
  • Invasive coronary angiography

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