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Multicenter Study
. 2023 Nov 1;46(11):2015-2023.
doi: 10.2337/dc23-0710.

Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

Theodora Benedek  1   2 , Viktoria Wieske  3 , Bálint Szilveszter  4 , Klaus F Kofoed  5   6 , Patrick Donnelly  7 , José Rodriguez-Palomares  8   9 , Andrejs Erglis  10 , Josef Veselka  11 , Gintarė Šakalytė  12 , Nada Čemerlić Ađić  13   14 , Matthias Gutberlet  15 , Ignacio Diez  16 , Gershan Davis  17   18 , Elke Zimmermann  2 , Cezary Kępka  19 , Radosav Vidakovic  20   21 , Marco Francone  22   23 , Małgorzata Ilnicka-Suckiel  24 , Fabian Plank  25 , Juhani Knuuti  26 , Rita Faria  27 , Stephen Schröder  28 , Colin Berry  29   30 , Luca Saba  31 , Balazs Ruzsics  32   33 , Nina Rieckmann  34 , Christine Kubiak  35 , Kristian Schultz Hansen  36 , Jacqueline Müller-Nordhorn  37 , Bela Merkely  4 , Per E Sigvardsen  5   6 , Imre Benedek  38 , Clare Orr  7 , Filipa Xavier Valente  8   9 , Ligita Zvaigzne  10 , Martin Horváth  11 , Antanas Jankauskas  12 , Filip Ađić  13   14 , Michael Woinke  15 , Niall Mulvihill  39   40 , Iñigo Lecumberri  16 , Erica Thwaite  17   18 , Michael Laule  41 , Mariusz Kruk  19 , Milica Stefanovic  20 , Massimo Mancone  22   23 , Donata Kuśmierz  42 , Gudrun Feuchtner  43 , Mikko Pietilä  26   44 , Vasco Gama Ribeiro  27 , Tanja Drosch  28 , Christian Delles  29 , Marco Melis  22 , Michael Fisher  32   33   45 , Melinda Boussoussou  4 , Charlotte Kragelund  5 , Rosca Aurelian  46 , Stephanie Kelly  7 , Bruno Garcia Del Blanco  8   9 , Ainhoa Rubio  16 , Mihály Károlyi  4 , Jens D Hove  47   48 , Ioana Rodean  38 , Susan Regan  7 , Hug Cuéllar Calabria  49 , László Gellér  4 , Linnea Larsen  50 , Roxana Hodas  1 , Adriane E Napp  3 , Robert Haase  3 , Sarah Feger  3 , Mahmoud Mohamed  3 , Lina M Serna-Higuita  51 , Konrad Neumann  52 , Henryk Dreger  41   53 , Matthias Rief  3 , John Danesh  54 , Melanie Estrella  3 , Maria Bosserdt  3 , Peter Martus  51 , Jonathan D Dodd  40   55 , Marc Dewey  3   53   56   57   58
Affiliations
Multicenter Study

Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease

Theodora Benedek et al. Diabetes Care. .

Erratum in

  • Erratum. Computed Tomography Versus Invasive Coronary Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. Diabetes Care 2023;46:2015-2023.
    Benedek T, Wieske V, Szilveszter B, Kofoed KF, Donnelly P, Rodriguez-Palomares J, Erglis A, Veselka J, Šakalytė G, Ađić NČ, Gutberlet M, Diez I, Davis G, Zimmermann E, Kępka C, Vidakovic R, Francone M, Ilnicka-Suckiel M, Plank F, Knuuti J, Faria R, Schröder S, Berry C, Saba L, Ruzsics B, Rieckmann N, Kubiak C, Hansen KS, Müller-Nordhorn J, Merkely B, Sigvardsen PE, Benedek I, Orr C, Valente FX, Zvaigzne L, Horváth M, Jankauskas A, Ađić F, Woinke M, Mulvihill N, Lecumberri I, Thwaite E, Laule M, Kruk M, Stefanovic M, Mancone M, Kuśmierz D, Feuchtner G, Pietilä M, Ribeiro VG, Drosch T, Delles C, Melis M, Fisher M, Boussoussou M, Kragelund C, Aurelian R, Kelly S, Blanco BGD, Rubio A, Károlyi M, Hove JD, Rodean I, Regan S, Calabria HC, Gellér L, Larsen L, Hodas R, Napp AE, Haase R, Feger S, Mohamed M, Serna-Higuita LM, Neumann K, Dreger H, Rief M, Danesh J, Estrella M, Bosserdt M, Martus P, Dodd JD, Dewey M. Benedek T, et al. Diabetes Care. 2024 May 1;47(5):898. doi: 10.2337/dc24-er05a. Diabetes Care. 2024. PMID: 38381203 Free PMC article. No abstract available.

Abstract

Objective: To compare cardiac computed tomography (CT) with invasive coronary angiography (ICA) as the initial strategy in patients with diabetes and stable chest pain.

Research design and methods: This prespecified analysis of the multicenter DISCHARGE trial in 16 European countries was performed in patients with stable chest pain and intermediate pretest probability of coronary artery disease. The primary end point was a major adverse cardiac event (MACE) (cardiovascular death, nonfatal myocardial infarction, or stroke), and the secondary end point 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 of whom 557 (CT group n = 263 vs. ICA group n = 294) had diabetes and 2,984 (CT group n = 1,536 vs. ICA group n = 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 end point occurred less frequently in the CT group than in the ICA group (3.8% [10 of 263] vs. 8.2% [24 of 294], hazard ratio [HR] 0.45 [95% CI 0.22-0.95]), as did the major procedure-related complication rate (0.4% [1 of 263] vs. 2.7% [8 of 294], HR 0.30 [95% CI 0.13 - 0.63]).

Conclusions: In patients with diabetes referred for 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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Conflict of interest statement

Duality of Interest. T.B. received grants from the Romanian Ministry of European Funds, the Romanian Government, and the European Union. K.F.K. received grants from AP Møller og hustru; Chastine McKinney Møllers Fond; Danish Heart Foundation; the Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research; and the Health Insurance Company Denmark and an unrestricted research grant from Canon Medical Corporation and GE Healthcare. E.Z. received grants from Deutsche Forschungsgemeinschaft. J.K. received personal fees from AstraZeneca and GE Healthcare. C.B. received grants to his institution from AstraZeneca, Abbott Vascular, GlaxoSmithKline, HeartFlow, Menarini, Novartis, and Siemens and other financial or nonfinancial interests from the British Heart Foundation. N.R. is a principal investigator for a grant from the German Ministry of Education and Research. B.M. received personal fees from Biotronik, Medtronic, and Abbott and a grant from Boston Scientific. I.B. receive grants from the Romanian Ministry of European Funds, Romanian Government, and European Union. M.Kr. received grants to his institution from the National Science Center (Poland) and reports patents EP3157444B1 (granted), WO2015193847A1 (pending), and WO2013060883A4 (pending). M.R. received a grant from Deutsche Forschungsgemeinschaft. M.D. received grant support from the German Research Foundation; received funding from the Berlin University Alliance and the Digital Health Accelerator of the Berlin Institute of Health; is an editor for Springer Nature; receives other from Hands-on Cardiac CT Course (https://www.ct-kurs.de); receives funding through institutional research agreements with Siemens, General Electric, Philips, and Canon; holds a patent on fractal analysis of perfusion imaging (jointly with Florian Michallek, PCT/EP2016/071551 and USPTO 2021 10,991,109 approved); was a European Society of Radiology research chair (2019–2022); and is publications chair (2022–2025) for the European Society of Radiology. P.E.S. received consulting fees from Novo Nordisk outside the submitted work. G.Š. received payment or honoraria for lectures from Amgen, AstraZeneca, Bayer (Sanofi Aventis), Berlin Chemie Menarini, Baltic (Servier Pharma), and IQVIA; travel support from Servier and Novartis; participated on a data safety monitoring committee for Boehringer Ingelheim; and is a member of the Lithuanian Society of Cardiology, Lithuanian Heart Association, and Lithuanian Hypertension Society. M.G. received payment or honoraria to his institution for lectures from Bayer, Siemens, Bracco, and the German Roentgen Society and reported unpaid membership on a scientific committee for European Society for Cardiovascular Radiology and working group for the German Roentgen Society. J.K. received payment or honoraria for lectures from GE Healthcare, Merck, Lundbeck, and Boehringer Ingelheim; speaker’s fees from Bayer, Boehringer-Ingelheim, and Pfizer; and other financial and nonfinancial interests from the European Society of Cardiology. J.D.D. is an associate editor for Radiology, a member for the editorial board for Radiology and Cardiothoracic Imaging, and an associate editor for the Quarterly Journal of Medicine, all nonpaid, and is a coauthor of book chapters published by Elsevier.

Figures

None
Graphical abstract
Figure 1
Figure 1
Forest plot of interactions between patients with and without diabetes and initial testing strategy (CT vs. ICA) for MACE and expanded MACE calculated using subdistribution Cox proportional hazards models with Fine and Gray adjustment for competing risks. Nonfatal stroke and major procedure-related complications occurred less frequently in patients with diabetes in the CT group.
Figure 2
Figure 2
Time-to-event curves for MACE and expanded MACE end points. A: At a median follow-up of 3.5 years, no interactions were found between patients with and without diabetes and initial testing strategy (CT vs. ICA) for MACE (P for interaction = 0.45). B: At a median follow-up of 3.5 years, no interactions were found between patients with and without diabetes and initial testing strategy (CT vs. ICA) for expanded MACE. However, the HRs for expanded MACE occurred less frequently in patients with diabetes in the CT group compared with the ICA group (0.45 [95% CI 0.22–0.95]) compared with patients without diabetes (0.68 [95% CI 0.45–1.02]).
See this image and copyright information in PMC

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