CT Matches Invasive Angiography for Long-Term Chest Pain Care

A recent secondary analysis of the DISCHARGE randomized clinical trial, published in JAMA Cardiology, evaluated whether CT offers long-term benefits comparable to those of invasive coronary angiography (ICA) for patients with stable chest pain.

The study included 3,561 participants across 26 European centers, with a median follow-up of 3.5 years. Patients were randomly assigned to undergo either CT or ICA as the first diagnostic test for suspected coronary artery disease. The primary focus was on long-term health-related quality of life (QOL) and chest pain outcomes.

The study’s primary QOL measures were the Euro QOL 5-dimensions descriptive system (EQ-5D-3L) visual analog scale (EQ-5D-3L-VAS) and the 12-item Short Form Health Survey physical component score (SF-12-PCS). Angina was the main chest pain outcome.

In the total cohort of 3,561 patients (mean age, 60.1±10.1 years; 56.2% female), follow-up health status assessments were completed by 96.0% of the CT group (n=1,735) and 95.3% of the ICA group (n=1,671) over a 3.5-year period. Health-related QOL outcomes improved significantly in both groups, with no clinically meaningful differences between strategies.

The mean improvement in EQ-5D-3L-VAS from baseline to 3.5 years was 4.0 (95% CI, 3.1-4.9; P<0.001) in the CT group and 4.6 (95% CI, 3.6-5.6; P=0.002) in the ICA group. All QOL domains showed significant gains except for depressive symptoms, which improved only in the CT arm (mean change, –0.2; 95% CI, –0.4 to 0; P=0.04 vs P=0.12 for ICA).

Women presented with significantly lower baseline QOL than men, as reflected in EQ-5D-3L-VAS (mean difference, 5.2; 95% CI, 4.0-6.3; P<0.001), a disparity that persisted at 3.5 years (mean difference, 3.1; 95% CI, 1.9-4.4; P<0.001).

Angina prevalence at 3.5 years was similar across treatment arms. However, within the ICA group, women reported a higher 1-year angina rate than men (10.2% vs 6.2%; P=0.007), a sex-based difference not observed in the CT group.

“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,” the researchers concluded.

Reference

The DISCHARGE Trial Group. JAMA Cardiol. Published online May 14, 2025. doi:10.1001/jamacardio.2025.0992