TY - JOUR

T1 - Effect of Body Mass Index on Effectiveness of CT versus Invasive Coronary Angiography in Stable Chest Pain

T2 - The DISCHARGE Trial

AU - Sykes, Robert

AU - Collison, Damien

AU - Merkely, Bela

AU - Kofoed, Klaus F.

AU - Donnelly, Patrick

AU - Rodríguez-Palomares, José

AU - Erglis, Andrejs

AU - Veselka, Josef

AU - Šakalytė, Gintarė

AU - Ađić, Nada Čemerlić

AU - Gutberlet, Matthias

AU - Dodd, Jonathan D.

AU - Diez, Ignacio

AU - Davis, Gershan

AU - Zimmermann, Elke

AU - Kępka, Cezary

AU - Vidakovic, Radosav

AU - Francone, Marco

AU - Ilnicka-Suckiel, Małgorzata

AU - Plank, Fabian

AU - Knuuti, Juhani

AU - Faria, Rita

AU - Schröder, Stephen

AU - Berry, Colin

AU - Saba, Luca

AU - Ruzsics, Balazs

AU - Rieckmann, Nina

AU - Kubiak, Christine

AU - Hansen, Kristian Schultz

AU - Müller-Nordhorn, Jacqueline

AU - Maurovich-Horvat, Pál

AU - Knudsen, Andreas D.

AU - Benedek, Imre

AU - Orr, Clare

AU - Valente, Filipa Xavier

AU - Zvaigzne, Ligita

AU - Horváth, Martin

AU - Jankauskas, Antanas

AU - Ađić, Filip

AU - Woinke, Michael

AU - Keane, Stephen

AU - Lecumberri, Iñigo

AU - Thwaite, Erica

AU - Laule, Michael

AU - Kruk, Mariusz

AU - Zivanic, Aleksandra

AU - Mancone, Massimo

AU - Kuśmierz, Donata

AU - Abdulla, Jawdat

AU - Jurlander, Birgit

AU - DISCHARGE Trial Group

PY - 2024

Y1 - 2024

N2 - Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%-60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m2, respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m² exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. Clinical trial registration no. NCT02400229

AB - Background Recent trials support the role of cardiac CT in the evaluation of symptomatic patients suspected of having coronary artery disease (CAD); however, body mass index (BMI) has been reported to negatively impact CT image quality. Purpose To compare initial use of CT versus invasive coronary angiography (ICA) on clinical outcomes in patients with stable chest pain stratified by BMI category. Materials and Methods This prospective study represents a prespecified BMI subgroup analysis of the multicenter Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) trial conducted between October 2015 and April 2019. Adult patients with stable chest pain and a CAD pretest probability of 10%-60% were randomly assigned to undergo initial CT or ICA. The primary end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal myocardial infarction, or stroke. The secondary end point was an expanded MACE composite, including transient ischemic attack, and major procedure-related complications. Competing risk analyses were performed using the Fine and Gray subdistribution Cox proportional hazard model to assess the impact of the relationship between BMI and initial management with CT or ICA on the study outcomes, whereas noncardiovascular death and unknown causes of death were considered competing risk events. Results Among the 3457 participants included, 831 (24.0%), 1358 (39.3%), and 1268 (36.7%) had a BMI of less than 25, between 25 and 30, and greater than 30 kg/m2, respectively. No interaction was found between CT or ICA and BMI for MACE (P = .29), the expanded MACE composite (P = .38), or major procedure-related complications (P = .49). Across all BMI subgroups, expanded MACE composite events (CT, 10 of 409 [2.4%] to 23 of 697 [3.3%]; ICA, 26 of 661 [3.9%] to 21 of 422 [5.1%]) and major procedure-related complications during initial management (CT, one of 638 [0.2%] to five of 697 [0.7%]; ICA, nine of 630 [1.4%] to 12 of 422 [2.9%]) were less frequent in the CT versus ICA group. Participants with a BMI exceeding 30 kg/m² exhibited a higher nondiagnostic CT rate (7.1%, P = .044) compared to participants with lower BMI. Conclusion There was no evidence of a difference in outcomes between CT and ICA across the three BMI subgroups. Clinical trial registration no. NCT02400229

U2 - 10.1148/radiol.230591

DO - 10.1148/radiol.230591

M3 - Journal article

C2 - 38349247

AN - SCOPUS:85185142629

VL - 310

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 2

M1 - e230591

ER -