For patients with stable chest pain and intermediate pretest probability of coronary artery disease (CAD) referred for invasive coronary angiography (ICA), the risk of major adverse cardiovascular events is similar with use of computed tomography (CT) or ICA, according to a study published online March 4 in the New England Journal of Medicine. The research was published to coincide with the annual European Congress of Radiology, held virtually from March 2 to 6.
Pál Maurovich-Horvat, M.D., Ph.D., M.P.H., from Semmelweis University in Budapest, Hungary, and colleagues compared CT with ICA as initial diagnostic imaging strategies for guiding treatment of patients with stable chest pain and intermediate pretest probability of obstructive CAD. The primary outcome was major adverse cardiovascular events over 3.5 years. A total of 3,561 patients were included in the analysis: 1,808 in the CT group and 1,753 in the ICA group.
The researchers found that major adverse cardiovascular events occurred in 2.1 and 3.0 percent of patients in the CT and ICA groups, respectively (hazard ratio, 0.70; 95 percent confidence interval, 0.46 to 1.07; P = 0.10). Major procedure-related complications occurred in 0.5 and 1.9 percent of patients in the CT and ICA groups, respectively (hazard ratio, 0.26; 95 percent confidence interval, 0.13 to 0.55). Angina was reported during the final four weeks of follow-up in 8.8 and 7.5 percent of patients in the CT and ICA groups, respectively (odds ratio, 1.17; 95 percent confidence interval, 0.92 to 1.48).
“We found that a strategy of initial CT resulted in no significant difference in the incidence of major adverse cardiovascular events as compared with ICA but was associated with a lower risk of major procedure-related complications and revascularization procedures,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical and medical device industries.
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