DISCHARGE
Research type
Research Study
Full title
Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease: Comparative Effectiveness Research of Existing Technologies (DISCHARGE)
IRAS ID
154793
Contact name
Colin Berry
Contact email
Sponsor organisation
Charité Universitätsmedizin Berlin
Clinicaltrials.gov Identifier
Duration of Study in the UK
3 years, 0 months, 28 days
Research summary
Research Summary
The DISCHARGE trial will compare two methods to assess coronary arteries in patients with stable chest pain (angina): invasive coronary angiography (ICA), and non-invasive cardiac computed tomography (CTA). In brief, coronary angiography is an invasive procedure that provides information on the structure and function of the heart. It has an established role in the diagnosis of coronary artery disease however can lead to bleeding at the catheter entry site and rarely complications such as arrhythmias and heart attacks. In many cases significant stenoses can be treated during the session for example with a stent negating the need for a second procedure.
Cardiac CT is a non-invasive procedure that also provides information on the structure and function of the heart and has the advantage of also generating information on other organs such as the lungs. However CTA has it's own risk's associated as it exposes patients to radiation and contrast agents, and in case there are significant coronary stenoses invasive angiography would then have to be performed as a sepearte procedure either to treat the stenosis (e.g. with a stent) or to provide further information to plan bypass surgery.Patients with stable angina who are referred for ICA and have a low to intermediate risk of coronary artery disease will be randomised to either of the two tests. We hypothesise that in the majority of such patients the cardiac CT will provide sufficient information and that therefore the invasive investigation can be avoided. We will study cardiac events over up to four years of follow-up and hypothesise that there will be fewer events in patients who will undergo cardiac CT compared to those who will undergo coronary angiography.
Summary of Results
There was no difference in the incidence of major cardiovascular adverse events in patients referred for investigation of stable chest pain with an intermediate risk of coronary artery disease (CAD) randomised (toss of a coin) to either an invasive coronary angiogram (ICA) or non-invasive imaging (cardiac computed tomography). The overall incidence of major cardiovascular adverse events in all patients was lower than expected, possibly reflecting an improvement in ICA techniques and cardiovascular treatments across this large multicentre trial.Of those patients who had the non-invasive imaging first, 22% went on to require the more invasive procedure for treatment. There was a lower risk of major procedure related complications through the use of the non-invasive imaging for diagnosis over the invasive angiography.
REC name
West of Scotland REC 3
REC reference
15/WS/0286
Date of REC Opinion
23 Dec 2015
REC opinion
Favourable Opinion