Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial
Objectives To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. Materials and methods This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE tr...
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| Veröffentlicht in: | European radiology 2024-06, Vol.34 (6), p.4127-4141 |
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| creator | Mancone, Massimo Mézquita, Aldo J. Vázquez Birtolo, Lucia Ilaria Maurovich-Horvat, Pal Kofoed, Klaus F. Benedek, Theodora Donnelly, Patrick Rodriguez-Palomares, Jose Erglis, Andrejs Štěchovský, Cyril Šakalytė, Gintare Ađić, Nada Čemerlić Gutberlet, Matthias Diez, Ignacio Davis, Gershan Zimmermann, Elke Kępka, Cezary Vidakovic, Radosav Francone, Marco Ilnicka-Suckiel, Małgorzata Plank, Fabian Knuuti, Juhanni Faria, Rita Schröder, Stephen Berry, Colin Saba, Luca Ruzsics, Balazs Rieckmann, Nina Kubiak, Christine Hansen, Kristian Schultz Müller-Nordhorn, Jaqueline Merkely, Bela Sigvardsen, Per E. Benedek, Imre Orr, Clare Valente, Filipa Xavier Zvaigzne, Ligita Suchánek, Vojtěch Jankauskas, Antanas Ađić, Filip Woinke, Michael Keane, Stephen Lecumberri, Ignacio Thwaite, Erica Kruk, Mariusz Jovanovic, Vladimir Kuśmierz, Donata Feuchtner, Gudren Pietilä, Mikko Ribeiro, Vasco Gama Drosch, Tanja Delles, Christian Palmisano, Vitanio Fisher, Michael Drobni, Zsófia D. Kragelund, Charlotte Aurelian, Rosca Kelly, Stephanie del Blanco, Bruno Garcia Rubio, Ainhoa Boussoussou, Melinda Hove, Jens D. Rodean, Ioana Regan, Susan Calabria, Hug Cuéllar Becker, Dávid Larsen, Linnea Hodas, Roxana Napp, Adriane E. Haase, Robert Feger, Sarah Mohamed, Mahmoud Neumann, Konrad Dreger, Henryk Rief, Matthias Wieske, Viktoria Douglas, Pamela S. Estrella, Melanie Bosserdt, Maria Martus, Peter Serna-Higuita, Lina M. Dodd, Jonathan D. Dewey, Marc |
| description | Objectives
To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.
Materials and methods
This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).
Results
Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (
p
for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (
p
= 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81;
p
= 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.
Conclusion
For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.
Clinical relevance statement
This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.
Trial registration
ClinicalTrials.gov NCT02400229.
Key Points
• No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography.
• A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status.
• A CT-first strategy is safe and effective for stable chest pain pa |
| doi_str_mv | 10.1007/s00330-023-10355-2 |
| format | Article |
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To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.
Materials and methods
This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).
Results
Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (
p
for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (
p
= 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81;
p
= 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.
Conclusion
For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.
Clinical relevance statement
This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.
Trial registration
ClinicalTrials.gov NCT02400229.
Key Points
• No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography.
• A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status.
• A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
Graphical Abstract</description><identifier>ISSN: 1432-1084</identifier><identifier>ISSN: 0938-7994</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-023-10355-2</identifier><identifier>PMID: 37991508</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aged ; Angiography ; Cardiac ; Cardiovascular disease ; Cerebral infarction ; Chest ; Computed tomography ; Coronary Angiography - methods ; Coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Coronary vessels ; Diagnostic Radiology ; Disease detection ; Female ; Heart diseases ; Humans ; Imaging ; Internal Medicine ; Interventional Radiology ; Ischemia ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Middle Aged ; Myocardial infarction ; Neuroradiology ; Pain ; Patient Discharge ; Prospective Studies ; Radiology ; Risk Factors ; Smoking ; Smoking - adverse effects ; Subgroups ; Tomography, X-Ray Computed - methods ; Transient ischemic attack ; Ultrasound ; Vein & artery diseases</subject><ispartof>European radiology, 2024-06, Vol.34 (6), p.4127-4141</ispartof><rights>The Author(s), under exclusive licence to European Society of Radiology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to European Society of Radiology.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-24f89dd6d5b8b02c278ead163de937e687cab91fff53cec21fa412309026d81d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-023-10355-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-023-10355-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37991508$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mancone, Massimo</creatorcontrib><creatorcontrib>Mézquita, Aldo J. Vázquez</creatorcontrib><creatorcontrib>Birtolo, Lucia Ilaria</creatorcontrib><creatorcontrib>Maurovich-Horvat, Pal</creatorcontrib><creatorcontrib>Kofoed, Klaus F.</creatorcontrib><creatorcontrib>Benedek, Theodora</creatorcontrib><creatorcontrib>Donnelly, Patrick</creatorcontrib><creatorcontrib>Rodriguez-Palomares, Jose</creatorcontrib><creatorcontrib>Erglis, Andrejs</creatorcontrib><creatorcontrib>Štěchovský, Cyril</creatorcontrib><creatorcontrib>Šakalytė, Gintare</creatorcontrib><creatorcontrib>Ađić, Nada Čemerlić</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Diez, Ignacio</creatorcontrib><creatorcontrib>Davis, Gershan</creatorcontrib><creatorcontrib>Zimmermann, Elke</creatorcontrib><creatorcontrib>Kępka, Cezary</creatorcontrib><creatorcontrib>Vidakovic, Radosav</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Ilnicka-Suckiel, Małgorzata</creatorcontrib><creatorcontrib>Plank, Fabian</creatorcontrib><creatorcontrib>Knuuti, Juhanni</creatorcontrib><creatorcontrib>Faria, Rita</creatorcontrib><creatorcontrib>Schröder, Stephen</creatorcontrib><creatorcontrib>Berry, Colin</creatorcontrib><creatorcontrib>Saba, Luca</creatorcontrib><creatorcontrib>Ruzsics, Balazs</creatorcontrib><creatorcontrib>Rieckmann, Nina</creatorcontrib><creatorcontrib>Kubiak, Christine</creatorcontrib><creatorcontrib>Hansen, Kristian Schultz</creatorcontrib><creatorcontrib>Müller-Nordhorn, Jaqueline</creatorcontrib><creatorcontrib>Merkely, Bela</creatorcontrib><creatorcontrib>Sigvardsen, Per E.</creatorcontrib><creatorcontrib>Benedek, Imre</creatorcontrib><creatorcontrib>Orr, Clare</creatorcontrib><creatorcontrib>Valente, Filipa Xavier</creatorcontrib><creatorcontrib>Zvaigzne, Ligita</creatorcontrib><creatorcontrib>Suchánek, Vojtěch</creatorcontrib><creatorcontrib>Jankauskas, Antanas</creatorcontrib><creatorcontrib>Ađić, Filip</creatorcontrib><creatorcontrib>Woinke, Michael</creatorcontrib><creatorcontrib>Keane, Stephen</creatorcontrib><creatorcontrib>Lecumberri, Ignacio</creatorcontrib><creatorcontrib>Thwaite, Erica</creatorcontrib><creatorcontrib>Kruk, Mariusz</creatorcontrib><creatorcontrib>Jovanovic, Vladimir</creatorcontrib><creatorcontrib>Kuśmierz, Donata</creatorcontrib><creatorcontrib>Feuchtner, Gudren</creatorcontrib><creatorcontrib>Pietilä, Mikko</creatorcontrib><creatorcontrib>Ribeiro, Vasco Gama</creatorcontrib><creatorcontrib>Drosch, Tanja</creatorcontrib><creatorcontrib>Delles, Christian</creatorcontrib><creatorcontrib>Palmisano, Vitanio</creatorcontrib><creatorcontrib>Fisher, Michael</creatorcontrib><creatorcontrib>Drobni, Zsófia D.</creatorcontrib><creatorcontrib>Kragelund, Charlotte</creatorcontrib><creatorcontrib>Aurelian, Rosca</creatorcontrib><creatorcontrib>Kelly, Stephanie</creatorcontrib><creatorcontrib>del Blanco, Bruno Garcia</creatorcontrib><creatorcontrib>Rubio, Ainhoa</creatorcontrib><creatorcontrib>Boussoussou, Melinda</creatorcontrib><creatorcontrib>Hove, Jens D.</creatorcontrib><creatorcontrib>Rodean, Ioana</creatorcontrib><creatorcontrib>Regan, Susan</creatorcontrib><creatorcontrib>Calabria, Hug Cuéllar</creatorcontrib><creatorcontrib>Becker, Dávid</creatorcontrib><creatorcontrib>Larsen, Linnea</creatorcontrib><creatorcontrib>Hodas, Roxana</creatorcontrib><creatorcontrib>Napp, Adriane E.</creatorcontrib><creatorcontrib>Haase, Robert</creatorcontrib><creatorcontrib>Feger, Sarah</creatorcontrib><creatorcontrib>Mohamed, Mahmoud</creatorcontrib><creatorcontrib>Neumann, Konrad</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Rief, Matthias</creatorcontrib><creatorcontrib>Wieske, Viktoria</creatorcontrib><creatorcontrib>Douglas, Pamela S.</creatorcontrib><creatorcontrib>Estrella, Melanie</creatorcontrib><creatorcontrib>Bosserdt, Maria</creatorcontrib><creatorcontrib>Martus, Peter</creatorcontrib><creatorcontrib>Serna-Higuita, Lina M.</creatorcontrib><creatorcontrib>Dodd, Jonathan D.</creatorcontrib><creatorcontrib>Dewey, Marc</creatorcontrib><title>Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objectives
To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.
Materials and methods
This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).
Results
Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (
p
for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (
p
= 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81;
p
= 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.
Conclusion
For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.
Clinical relevance statement
This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.
Trial registration
ClinicalTrials.gov NCT02400229.
Key Points
• No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography.
• A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status.
• A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
Graphical Abstract</description><subject>Aged</subject><subject>Angiography</subject><subject>Cardiac</subject><subject>Cardiovascular disease</subject><subject>Cerebral infarction</subject><subject>Chest</subject><subject>Computed tomography</subject><subject>Coronary Angiography - methods</subject><subject>Coronary artery disease</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary vessels</subject><subject>Diagnostic Radiology</subject><subject>Disease detection</subject><subject>Female</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Neuroradiology</subject><subject>Pain</subject><subject>Patient Discharge</subject><subject>Prospective Studies</subject><subject>Radiology</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Smoking - adverse effects</subject><subject>Subgroups</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Transient ischemic attack</subject><subject>Ultrasound</subject><subject>Vein & artery diseases</subject><issn>1432-1084</issn><issn>0938-7994</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1PGzEQhq0KVNK0f6CHyhIXLgtje798jFIKkSIhAT1bjj2Gpdn1YntV8e_rNJQiDpzGH8_7zmheQr4yOGUAzVkEEAIK4KJgIKqq4B_IjJWC52tbHrw6H5FPMT4AgGRl85EciUZKVkE7I27Vj9ok6h2Nvf_VDXe0G-ioU4dDivR3l-5pnOKIJqGlxgc_6PBEdUiYi-0i6og7SbpHGvRgfZ_fLP2-ulleLq4vzmkKnd5-JodObyN-ea5z8vPH-e3yslhfXayWi3VhBK9TwUvXSmtrW23aDXDDmxa1ZbWwKEWDddsYvZHMOVcJg4Yzp0vGBUjgtW2ZFXNysvcdg3-cMCaVxzG43eoB_RQVbyWvK1lCldHjN-iDn8KQp1MC6gw1Tc0zxfeUCT7GgE6NoevzChQDtUtB7VNQOQX1NwW1E317tp42PdoXyb-1Z0DsgZi_hjsM_3u_Y_sHFAySAg</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Mancone, Massimo</creator><creator>Mézquita, Aldo J. Vázquez</creator><creator>Birtolo, Lucia Ilaria</creator><creator>Maurovich-Horvat, Pal</creator><creator>Kofoed, Klaus F.</creator><creator>Benedek, Theodora</creator><creator>Donnelly, Patrick</creator><creator>Rodriguez-Palomares, Jose</creator><creator>Erglis, Andrejs</creator><creator>Štěchovský, Cyril</creator><creator>Šakalytė, Gintare</creator><creator>Ađić, Nada Čemerlić</creator><creator>Gutberlet, Matthias</creator><creator>Diez, Ignacio</creator><creator>Davis, Gershan</creator><creator>Zimmermann, Elke</creator><creator>Kępka, Cezary</creator><creator>Vidakovic, Radosav</creator><creator>Francone, Marco</creator><creator>Ilnicka-Suckiel, Małgorzata</creator><creator>Plank, Fabian</creator><creator>Knuuti, Juhanni</creator><creator>Faria, Rita</creator><creator>Schröder, Stephen</creator><creator>Berry, Colin</creator><creator>Saba, Luca</creator><creator>Ruzsics, Balazs</creator><creator>Rieckmann, Nina</creator><creator>Kubiak, Christine</creator><creator>Hansen, Kristian Schultz</creator><creator>Müller-Nordhorn, Jaqueline</creator><creator>Merkely, Bela</creator><creator>Sigvardsen, Per E.</creator><creator>Benedek, Imre</creator><creator>Orr, Clare</creator><creator>Valente, Filipa Xavier</creator><creator>Zvaigzne, Ligita</creator><creator>Suchánek, Vojtěch</creator><creator>Jankauskas, Antanas</creator><creator>Ađić, Filip</creator><creator>Woinke, Michael</creator><creator>Keane, Stephen</creator><creator>Lecumberri, Ignacio</creator><creator>Thwaite, Erica</creator><creator>Kruk, Mariusz</creator><creator>Jovanovic, Vladimir</creator><creator>Kuśmierz, Donata</creator><creator>Feuchtner, Gudren</creator><creator>Pietilä, Mikko</creator><creator>Ribeiro, Vasco Gama</creator><creator>Drosch, Tanja</creator><creator>Delles, Christian</creator><creator>Palmisano, Vitanio</creator><creator>Fisher, Michael</creator><creator>Drobni, Zsófia D.</creator><creator>Kragelund, Charlotte</creator><creator>Aurelian, Rosca</creator><creator>Kelly, Stephanie</creator><creator>del Blanco, Bruno Garcia</creator><creator>Rubio, Ainhoa</creator><creator>Boussoussou, Melinda</creator><creator>Hove, Jens D.</creator><creator>Rodean, Ioana</creator><creator>Regan, Susan</creator><creator>Calabria, Hug Cuéllar</creator><creator>Becker, Dávid</creator><creator>Larsen, Linnea</creator><creator>Hodas, Roxana</creator><creator>Napp, Adriane E.</creator><creator>Haase, Robert</creator><creator>Feger, Sarah</creator><creator>Mohamed, Mahmoud</creator><creator>Neumann, Konrad</creator><creator>Dreger, Henryk</creator><creator>Rief, Matthias</creator><creator>Wieske, Viktoria</creator><creator>Douglas, Pamela S.</creator><creator>Estrella, Melanie</creator><creator>Bosserdt, Maria</creator><creator>Martus, Peter</creator><creator>Serna-Higuita, Lina M.</creator><creator>Dodd, Jonathan D.</creator><creator>Dewey, Marc</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20240601</creationdate><title>Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial</title><author>Mancone, Massimo ; Mézquita, Aldo J. Vázquez ; Birtolo, Lucia Ilaria ; Maurovich-Horvat, Pal ; Kofoed, Klaus F. ; Benedek, Theodora ; Donnelly, Patrick ; Rodriguez-Palomares, Jose ; Erglis, Andrejs ; Štěchovský, Cyril ; Šakalytė, Gintare ; Ađić, Nada Čemerlić ; Gutberlet, Matthias ; Diez, Ignacio ; Davis, Gershan ; Zimmermann, Elke ; Kępka, Cezary ; Vidakovic, Radosav ; Francone, Marco ; Ilnicka-Suckiel, Małgorzata ; Plank, Fabian ; Knuuti, Juhanni ; Faria, Rita ; Schröder, Stephen ; Berry, Colin ; Saba, Luca ; Ruzsics, Balazs ; Rieckmann, Nina ; Kubiak, Christine ; Hansen, Kristian Schultz ; Müller-Nordhorn, Jaqueline ; Merkely, Bela ; Sigvardsen, Per E. ; Benedek, Imre ; Orr, Clare ; Valente, Filipa Xavier ; Zvaigzne, Ligita ; Suchánek, Vojtěch ; Jankauskas, Antanas ; Ađić, Filip ; Woinke, Michael ; Keane, Stephen ; Lecumberri, Ignacio ; Thwaite, Erica ; Kruk, Mariusz ; Jovanovic, Vladimir ; Kuśmierz, Donata ; Feuchtner, Gudren ; Pietilä, Mikko ; Ribeiro, Vasco Gama ; Drosch, Tanja ; Delles, Christian ; Palmisano, Vitanio ; Fisher, Michael ; Drobni, Zsófia D. ; Kragelund, Charlotte ; Aurelian, Rosca ; Kelly, Stephanie ; del Blanco, Bruno Garcia ; Rubio, Ainhoa ; Boussoussou, Melinda ; Hove, Jens D. ; Rodean, Ioana ; Regan, Susan ; Calabria, Hug Cuéllar ; Becker, Dávid ; Larsen, Linnea ; Hodas, Roxana ; Napp, Adriane E. ; Haase, Robert ; Feger, Sarah ; Mohamed, Mahmoud ; Neumann, Konrad ; Dreger, Henryk ; Rief, Matthias ; Wieske, Viktoria ; Douglas, Pamela S. ; Estrella, Melanie ; Bosserdt, Maria ; Martus, Peter ; Serna-Higuita, Lina M. ; Dodd, Jonathan D. ; Dewey, Marc</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-24f89dd6d5b8b02c278ead163de937e687cab91fff53cec21fa412309026d81d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Angiography</topic><topic>Cardiac</topic><topic>Cardiovascular disease</topic><topic>Cerebral infarction</topic><topic>Chest</topic><topic>Computed tomography</topic><topic>Coronary Angiography - methods</topic><topic>Coronary artery disease</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary vessels</topic><topic>Diagnostic Radiology</topic><topic>Disease detection</topic><topic>Female</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Neuroradiology</topic><topic>Pain</topic><topic>Patient Discharge</topic><topic>Prospective Studies</topic><topic>Radiology</topic><topic>Risk Factors</topic><topic>Smoking</topic><topic>Smoking - adverse effects</topic><topic>Subgroups</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Transient ischemic attack</topic><topic>Ultrasound</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mancone, Massimo</creatorcontrib><creatorcontrib>Mézquita, Aldo J. Vázquez</creatorcontrib><creatorcontrib>Birtolo, Lucia Ilaria</creatorcontrib><creatorcontrib>Maurovich-Horvat, Pal</creatorcontrib><creatorcontrib>Kofoed, Klaus F.</creatorcontrib><creatorcontrib>Benedek, Theodora</creatorcontrib><creatorcontrib>Donnelly, Patrick</creatorcontrib><creatorcontrib>Rodriguez-Palomares, Jose</creatorcontrib><creatorcontrib>Erglis, Andrejs</creatorcontrib><creatorcontrib>Štěchovský, Cyril</creatorcontrib><creatorcontrib>Šakalytė, Gintare</creatorcontrib><creatorcontrib>Ađić, Nada Čemerlić</creatorcontrib><creatorcontrib>Gutberlet, Matthias</creatorcontrib><creatorcontrib>Diez, Ignacio</creatorcontrib><creatorcontrib>Davis, Gershan</creatorcontrib><creatorcontrib>Zimmermann, Elke</creatorcontrib><creatorcontrib>Kępka, Cezary</creatorcontrib><creatorcontrib>Vidakovic, Radosav</creatorcontrib><creatorcontrib>Francone, Marco</creatorcontrib><creatorcontrib>Ilnicka-Suckiel, Małgorzata</creatorcontrib><creatorcontrib>Plank, Fabian</creatorcontrib><creatorcontrib>Knuuti, Juhanni</creatorcontrib><creatorcontrib>Faria, Rita</creatorcontrib><creatorcontrib>Schröder, Stephen</creatorcontrib><creatorcontrib>Berry, Colin</creatorcontrib><creatorcontrib>Saba, Luca</creatorcontrib><creatorcontrib>Ruzsics, Balazs</creatorcontrib><creatorcontrib>Rieckmann, Nina</creatorcontrib><creatorcontrib>Kubiak, Christine</creatorcontrib><creatorcontrib>Hansen, Kristian Schultz</creatorcontrib><creatorcontrib>Müller-Nordhorn, Jaqueline</creatorcontrib><creatorcontrib>Merkely, Bela</creatorcontrib><creatorcontrib>Sigvardsen, Per E.</creatorcontrib><creatorcontrib>Benedek, Imre</creatorcontrib><creatorcontrib>Orr, Clare</creatorcontrib><creatorcontrib>Valente, Filipa Xavier</creatorcontrib><creatorcontrib>Zvaigzne, Ligita</creatorcontrib><creatorcontrib>Suchánek, Vojtěch</creatorcontrib><creatorcontrib>Jankauskas, Antanas</creatorcontrib><creatorcontrib>Ađić, Filip</creatorcontrib><creatorcontrib>Woinke, Michael</creatorcontrib><creatorcontrib>Keane, Stephen</creatorcontrib><creatorcontrib>Lecumberri, Ignacio</creatorcontrib><creatorcontrib>Thwaite, Erica</creatorcontrib><creatorcontrib>Kruk, Mariusz</creatorcontrib><creatorcontrib>Jovanovic, Vladimir</creatorcontrib><creatorcontrib>Kuśmierz, Donata</creatorcontrib><creatorcontrib>Feuchtner, Gudren</creatorcontrib><creatorcontrib>Pietilä, Mikko</creatorcontrib><creatorcontrib>Ribeiro, Vasco Gama</creatorcontrib><creatorcontrib>Drosch, Tanja</creatorcontrib><creatorcontrib>Delles, Christian</creatorcontrib><creatorcontrib>Palmisano, Vitanio</creatorcontrib><creatorcontrib>Fisher, Michael</creatorcontrib><creatorcontrib>Drobni, Zsófia D.</creatorcontrib><creatorcontrib>Kragelund, Charlotte</creatorcontrib><creatorcontrib>Aurelian, Rosca</creatorcontrib><creatorcontrib>Kelly, Stephanie</creatorcontrib><creatorcontrib>del Blanco, Bruno Garcia</creatorcontrib><creatorcontrib>Rubio, Ainhoa</creatorcontrib><creatorcontrib>Boussoussou, Melinda</creatorcontrib><creatorcontrib>Hove, Jens D.</creatorcontrib><creatorcontrib>Rodean, Ioana</creatorcontrib><creatorcontrib>Regan, Susan</creatorcontrib><creatorcontrib>Calabria, Hug Cuéllar</creatorcontrib><creatorcontrib>Becker, Dávid</creatorcontrib><creatorcontrib>Larsen, Linnea</creatorcontrib><creatorcontrib>Hodas, Roxana</creatorcontrib><creatorcontrib>Napp, Adriane E.</creatorcontrib><creatorcontrib>Haase, Robert</creatorcontrib><creatorcontrib>Feger, Sarah</creatorcontrib><creatorcontrib>Mohamed, Mahmoud</creatorcontrib><creatorcontrib>Neumann, Konrad</creatorcontrib><creatorcontrib>Dreger, Henryk</creatorcontrib><creatorcontrib>Rief, Matthias</creatorcontrib><creatorcontrib>Wieske, Viktoria</creatorcontrib><creatorcontrib>Douglas, Pamela S.</creatorcontrib><creatorcontrib>Estrella, Melanie</creatorcontrib><creatorcontrib>Bosserdt, Maria</creatorcontrib><creatorcontrib>Martus, Peter</creatorcontrib><creatorcontrib>Serna-Higuita, Lina M.</creatorcontrib><creatorcontrib>Dodd, Jonathan D.</creatorcontrib><creatorcontrib>Dewey, Marc</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mancone, Massimo</au><au>Mézquita, Aldo J. Vázquez</au><au>Birtolo, Lucia Ilaria</au><au>Maurovich-Horvat, Pal</au><au>Kofoed, Klaus F.</au><au>Benedek, Theodora</au><au>Donnelly, Patrick</au><au>Rodriguez-Palomares, Jose</au><au>Erglis, Andrejs</au><au>Štěchovský, Cyril</au><au>Šakalytė, Gintare</au><au>Ađić, Nada Čemerlić</au><au>Gutberlet, Matthias</au><au>Diez, Ignacio</au><au>Davis, Gershan</au><au>Zimmermann, Elke</au><au>Kępka, Cezary</au><au>Vidakovic, Radosav</au><au>Francone, Marco</au><au>Ilnicka-Suckiel, Małgorzata</au><au>Plank, Fabian</au><au>Knuuti, Juhanni</au><au>Faria, Rita</au><au>Schröder, Stephen</au><au>Berry, Colin</au><au>Saba, Luca</au><au>Ruzsics, Balazs</au><au>Rieckmann, Nina</au><au>Kubiak, Christine</au><au>Hansen, Kristian Schultz</au><au>Müller-Nordhorn, Jaqueline</au><au>Merkely, Bela</au><au>Sigvardsen, Per E.</au><au>Benedek, Imre</au><au>Orr, Clare</au><au>Valente, Filipa Xavier</au><au>Zvaigzne, Ligita</au><au>Suchánek, Vojtěch</au><au>Jankauskas, Antanas</au><au>Ađić, Filip</au><au>Woinke, Michael</au><au>Keane, Stephen</au><au>Lecumberri, Ignacio</au><au>Thwaite, Erica</au><au>Kruk, Mariusz</au><au>Jovanovic, Vladimir</au><au>Kuśmierz, Donata</au><au>Feuchtner, Gudren</au><au>Pietilä, Mikko</au><au>Ribeiro, Vasco Gama</au><au>Drosch, Tanja</au><au>Delles, Christian</au><au>Palmisano, Vitanio</au><au>Fisher, Michael</au><au>Drobni, Zsófia D.</au><au>Kragelund, Charlotte</au><au>Aurelian, Rosca</au><au>Kelly, Stephanie</au><au>del Blanco, Bruno Garcia</au><au>Rubio, Ainhoa</au><au>Boussoussou, Melinda</au><au>Hove, Jens D.</au><au>Rodean, Ioana</au><au>Regan, Susan</au><au>Calabria, Hug Cuéllar</au><au>Becker, Dávid</au><au>Larsen, Linnea</au><au>Hodas, Roxana</au><au>Napp, Adriane E.</au><au>Haase, Robert</au><au>Feger, Sarah</au><au>Mohamed, Mahmoud</au><au>Neumann, Konrad</au><au>Dreger, Henryk</au><au>Rief, Matthias</au><au>Wieske, Viktoria</au><au>Douglas, Pamela S.</au><au>Estrella, Melanie</au><au>Bosserdt, Maria</au><au>Martus, Peter</au><au>Serna-Higuita, Lina M.</au><au>Dodd, Jonathan D.</au><au>Dewey, Marc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>34</volume><issue>6</issue><spage>4127</spage><epage>4141</epage><pages>4127-4141</pages><issn>1432-1084</issn><issn>0938-7994</issn><eissn>1432-1084</eissn><abstract>Objectives
To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status.
Materials and methods
This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications).
Results
Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (
p
for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (
p
= 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81;
p
= 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy.
Conclusion
For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers.
Clinical relevance statement
This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status.
Trial registration
ClinicalTrials.gov NCT02400229.
Key Points
• No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography.
• A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status.
• A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
Graphical Abstract</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37991508</pmid><doi>10.1007/s00330-023-10355-2</doi><tpages>15</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1432-1084 |
| ispartof | European radiology, 2024-06, Vol.34 (6), p.4127-4141 |
| issn | 1432-1084 0938-7994 1432-1084 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2892659405 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Angiography Cardiac Cardiovascular disease Cerebral infarction Chest Computed tomography Coronary Angiography - methods Coronary artery disease Coronary Artery Disease - complications Coronary Artery Disease - diagnostic imaging Coronary vessels Diagnostic Radiology Disease detection Female Heart diseases Humans Imaging Internal Medicine Interventional Radiology Ischemia Male Medical imaging Medicine Medicine & Public Health Middle Aged Myocardial infarction Neuroradiology Pain Patient Discharge Prospective Studies Radiology Risk Factors Smoking Smoking - adverse effects Subgroups Tomography, X-Ray Computed - methods Transient ischemic attack Ultrasound Vein & artery diseases |
| title | Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial |
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