CT is a safe, comparable alternative to invasive coronary angiography for chest pain work-ups

For patients with stable chest pain and a probability of obstructive coronary artery disease, computed tomography is comparable to invasive coronary angiography when measuring risk for major cardiovascular events. 

That’s according to new research published in the New England Journal of Medicine that compared the adverse cardiovascular events for patients who received either CT or invasive coronary angiography (ICA) as their initial diagnostic imaging exam for chest pain workups. The study found that using CT as the initial imaging strategy resulted in fewer procedure-related complications without sacrificing prognostic value. 

This is a change from the reference standard of ICA for CAD diagnosis, which can cause rare but major complications for patients. Coronary CT angiography has found favor among physicians over the last several years due to its less invasive approach to assessing chest pain, and previous studies have observed the modality’s similar cardiovascular outcomes when compared to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography) and standard care. 

“CT has generated interest since it may rule out obstructive CAD in a noninvasive procedure with a low risk of adverse events as it identifies patients who are appropriate candidates for coronary revascularization,” wrote Marc Dewey, MD, with the department of radiology at Charité-Universitätsmedizin Berlin, and colleagues. 

The current study, Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease, or “DISCHARGE,” compared the effectiveness of CT and ICA for preventing major cardiovascular events, such as cardiovascular death, nonfatal myocardial infarction and nonfatal stroke, over a period of 3.5 years. 

Out of the 3,561 patients included in the research, follow-ups were completed on 3,523. For the CT group, major cardiovascular events were reported in 2.1% of participants, compared to 3% in the ICA group. In terms of major procedure-related complications, just .5% of participants were affected in the CT group, while the ICA group observed 1.9%. 

“We found no significant difference in the primary outcome of major adverse cardiovascular events,” the authors wrote. “Our trial confirmed the safety of a CT-first strategy and showed results that were similar to those with ICA.” 

More on cardiovascular imaging:

Photon-counting CT boosts image quality and reader confidence in identifying coronary artery disease

New treatment bolsters outcomes for advanced CAD patients, toppling angiography

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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.

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