Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jul 1;10(7):728-739.
doi: 10.1001/jamacardio.2025.0992.

Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

DISCHARGE Trial Group; Nina Rieckmann  1 , Konrad Neumann  1 , Pál Maurovich-Horvat  2   3 , Klaus F Kofoed  4   5   6 , Theodora Benedek  7   8 , Maria Bosserdt  9 , Patrick Donnelly  10 , José Rodriguez-Palomares  11   12 , Andrejs Erglis  13   14 , Cyril Štechovský  15 , Gintare Šakalyte  16   17 , Nada Cemerlic Adic  18   19 , Matthias Gutberlet  20 , Ignacio Diez  21 , Gershan Davis  22   23 , Elke Zimmermann  9 , Cezary Kepka  24 , Radosav Vidakovic  25   26 , Marco Francone  27 , Malgorzata Ilnicka-Suckiel  28 , Fabian Plank  29   30 , Juhani Knuuti  31 , Rita Faria  32 , Stephen Schröder  33 , Colin Berry  34   35 , Luca Saba  36 , Balazs Ruzsics  37   38 , Christine Kubiak  39 , Kristian Schultz Hansen  40 , Jacqueline Müller-Nordhorn  41 , Bela Merkely  3 , Andreas D Knudsen  42 , Imre Benedek  7   8 , Clare Orr  10 , Filipa Xavier Valente  11   12 , Ligita Zvaigzne  13 , Vojtech Suchánek  43 , Laura Zajanckauskiene  16   17 , Filip Adic  18   19 , Michael Woinke  20 , Darragh Waters  44 , Iñigo Lecumberri  21 , Erica Thwaite  22   23 , Michael Laule  45 , Mariusz Kruk  24 , Aleksandar N Neskovic  25   26 , Lucia Ilaria Birtolo  46 , Donata Kusmierz  28 , Gudrun Feuchtner  30 , Mikko Pietilä  31   47 , Vasco Gama Ribeiro  32 , Tanja Drosch  33 , Christian Delles  34 , Gildo Matta  34 , Michael Fisher  37   38 , Bálint Szilveszter  3 , Linnea Larsen  4   6 , Mihaela Ratiu  7   8 , Stephanie Kelly  10 , Bruno Garcia Del Blanco  11   12 , Zsófia D Drobni  3 , Birgit Jurlander  40 , Susan Regan  10 , Hug Cuéllar Calabria  11 , Melinda Boussoussou  3 , Thomas Engstrøm  4   6 , Roxana Hodas  7 , Adriane E Napp  9 , Robert Haase  9 , Sarah Feger  9 , Mahmoud M A Mohamed  9 , Henryk Dreger  45   48 , Matthias Rief  9 , Viktoria Wieske  9 , Melanie Estrella  9 , Florian Michallek  9 , Daniel B Mark  49 , Peter Martus  50 , Jonathan D Dodd  44   51 , Harold C Sox  52 , Lina M Serna-Higuita  50 , Marc Dewey  9   48   53   54   55
Collaborators, Affiliations
Randomized Controlled Trial

Health Status Outcomes After Computed Tomography or Invasive Coronary Angiography for Stable Chest Pain: A Prespecified Secondary Analysis of the DISCHARGE Randomized Clinical Trial

DISCHARGE Trial Group et al. JAMA Cardiol. .

Abstract

Importance: The effect of computed tomography (CT) vs invasive coronary angiography (ICA) on health status outcomes is unknown.

Objective: To evaluate CT and ICA first-test strategies on quality of life (QOL) and angina.

Design, setting, and participants: The Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial, conducted between October 2015 and April 2019 in 26 European centers, followed up patients with stable chest pain and intermediate probability of coronary artery disease for a median 3.5 years. Data analysis was from December 2023 to July 2024.

Interventions: Random assignment to CT or ICA.

Main outcomes and measures: Patient-reported Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and 12-item Short Form Health Survey (SF-12) physical component score (SF-12-PCS) were primary prespecified QOL outcomes. Angina was the primary prespecified chest pain outcome. The EQ-5D-3L-VAS, summary index (EQ-5D-3L-SI), mental component summary (SF-12-MCS), and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale-anxiety subscale (HADS-D) were also evaluated.

Results: Among 3561 patients (mean [SD] age, 60.1 [10.1] years; 2002 female [56.2%]), 1735 (96.0%) in the CT group and 1671 (95.3%) in the ICA group completed at least 1 health status assessment during 3.5 years of follow-up. Health status outcomes were similar between groups, with significant improvements in all QOL outcomes (eg, mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = 4.0; 95% CI, 3.1-4.9; P < .001; ICA = 4.6; 95% CI, 3.6-5.6; P =.002), except HADS-D, which improved only in the CT group (mean EQ-5D-3L-VAS 3.5 year minus baseline score: CT = -0.2; 95% CI, -0.4 to 0; P = .04; ICA = -0.2; 95% CI, -0.4 to 0; P = .12). Female patients had worse baseline and follow-up QOL than male patients (eg, baseline EQ-5D-3L-VAS difference between men and women = 5.2; 95% CI, 4.0-6.3; P <.001 and at 3.5 years = 3.1; 95% CI, 1.9-4.4; P < .001) but showed greater improvements in EQ-5D-3L-VAS (-1.9; 95% CI, -3.4 to -0.5; P = .009), SF-12-PCS (-1.4; -2.1 to -0.7; P < .001), and HADS-A (0.3; 0-0.7; P = .04). Angina outcomes were comparable between groups at 3.5 years, with similar 1-year rates in the CT group but higher rates in female than male patients in the ICA group (10.2% vs 6.2%; P = .007).

Conclusions and relevance: Results of this secondary analysis of the DISCHARGE randomized clinical trial reveal that there was no significant difference in QOL or chest pain outcomes with CT vs ICA at 3.5 years. Female patients had worse health status than male patients at baseline and follow-up, and CT or ICA did not affect these differences.

Trial registration: ClinicalTrials.gov Identifier: NCT02400229.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Rieckmann reported receiving grants from European Commission during the conduct of the study. Dr Maurovich-Horvat reported receiving grants from European Union during the conduct of the study. Dr Erglis reported receiving grants from EU 7th Framework during the conduct of the study. Dr Stechovsky reported receiving grants from European Commission during the conduct of the study. Dr Gutberlet reported receiving speaker/advisory board fees from Bayer outside the submitted work. Dr Knuuti reported receiving grants from European Union during the conduct of the study and consultant and/or speaker fees from GE Healthcare, Bayer, Boehringer Ingelheim, Pfizer, Siemens Healthineers, and Synektik Pharma outside the submitted work. Dr Faria reported receiving grants from Centro Hospitalar de Vila Nova de Gaia/ Espinho Grant from the European Commission during the conduct of the study. Dr Berry reported being employed by the University of Glasgow, which holds consultancy and research agreements for his work with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, CorFlow, Coroventis, HeartFlow, Menarini, Merck, Novartis, Siemens Healthcare, Xylocor, Zoll, and Valo Health and receiving research funding from the British Heart Foundation grant. Dr Kubiak reported receiving grants from EU Grant project during the conduct of the study. Dr Schultz Hansen reported receiving grants from EU-FP7 Framework Programme during the conduct of the study. Dr Merkely reported receiving personal fees from Abbott, AstraZeneca, Biotronik, Boehringer Ingelheim, CSL Behring, Daiichi Sankyo, Duke Clinical Institute, Medtronic, Novartis, and grants from Boston Scientific outside the submitted work. Dr Knudsen reported receiving grants from European 13 Commission (EU 7th Framework) and the Danish Heart Foundation outside the submitted work. Dr Valente reported receiving grants from European Commission during the conduct of the study. Dr Szilveszter reported receiving grants from EU-FP7 Framework Program during the conduct of the study. Dr Engstrøm reported receiving advisory board and/or speaker fees from Abbott, Boston Scientific, and Novo Nordisk outside the submitted work. Dr Napp reported receiving grants from European Commission Discharge during the conduct of the study; grants from Siemens Medical Solutions, GE Healthcare, Toshiba Medical Systems, and Philips Medical Systems outside the submitted work. Dr Feger reported receiving grants from European Commission FP7 Program during the conduct of the study. Dr Estrella reported receiving grants from European Commission EU 7th Framework during the conduct of the study. Dr Michallek reported receiving grants from German Research Foundation (Deutsche Forschungsgemeinschaft) during the conduct of the study and having a patent for EP3350773 issued (EPA) and a patent 10,991,109 issued (USPTO). Dr Mark reported receiving grants from HeartFlow, Merck, Novo Nordisk, and the National Institutes of Health; consulting fees from Boehringer Ingelheim and Novartis; and serving as editor in chief of the American Heart Journal during the conduct of the study. Dr Dodd reported receiving grants from European Union during the conduct of the study; personal fees from Amirsys as a coauthor for Cardiovascular Imaging Textbook and as a coauthor for a Cardiac CT and MRI textbook outside the submitted work; and serving as an associate editor for Radiology, Quarterly Journal of Medicine and Respirology, and an Editorial board member of Radiology Cardiothoracic Imaging (all unpaid). Dr Dewey reported receiving grants from FP7 Program of the European Commission, the German Research Foundation (DFG) graduate program on quantitative biomedical imaging, the German Research Foundation (DFG) for fractal analysis of myocardial perfusion, the German Research Foundation (DFG) the DFG Priority Programme Radiomics for the investigation of coronary plaque and coronary flow, the German Research Foundation (DFG) for the GUIDE-IT project on data sharing of medical imaging trials, the German Research Foundation (DFG) the Quantitative Cardiovascular Imaging (QCI) meeting, the German Research Foundation (DFG) the Future of Medical Imaging meeting, Berlin University Alliance GC_SC_PC 27, Innovationsfond of the G-BA for the IMPRO project, and Digital Health Accelerator of the Berlin Institute of Health for fractal analysis of CT and MRI outside the submitted work; having a patent for EPO 2022 EP3350773A1 issued on dynamic perfusion analysis using fractal analysis and a patent for USPTO 2021 10,991,109 issued on dynamic perfusion analysis using fractal analysis; and serving as European Society of Radiology Publications Chair from 2022-2025.No other disclosures were reported.

Comment in

References

    1. Xie J, Wu EQ, Zheng ZJ, Sullivan PW, Zhan L, Labarthe DR. Patient-reported health status in coronary heart disease in the US: age, sex, racial, and ethnic differences. Circulation. 2008;118(5):491-497. doi: 10.1161/CIRCULATIONAHA.107.752006 - DOI - PubMed
    1. Christoph M, Christoph A, Dannemann S, et al. Mental symptoms in patients with cardiac symptoms and normal coronary arteries. Open Heart. 2014;1(1):e000093. doi: 10.1136/openhrt-2014-000093 - DOI - PMC - PubMed
    1. Wang ZJ, Zhang LL, Elmariah S, Han HY, Zhou YJ. Prevalence and prognosis of nonobstructive coronary artery disease in patients undergoing coronary angiography or coronary computed tomography angiography: a meta-analysis. Mayo Clin Proc. 2017;92(3):329-346. doi: 10.1016/j.mayocp.2016.11.016 - DOI - PubMed
    1. Radico F, Zimarino M, Fulgenzi F, et al. Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis. Eur Heart J. 2018;39(23):2135-2146. doi: 10.1093/eurheartj/ehy185 - DOI - PubMed
    1. Mehta PK, Quesada O, Al-Badri A, et al. Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol. 2022;348:1-8. doi: 10.1016/j.ijcard.2021.12.013 - DOI - PMC - PubMed

Publication types

Associated data