DISCHARGE Trial Demonstrates Safety of Cardiac CT Versus Cardiac Catheterization for CAD Diagnosis

March 23, 2022—The Society of Cardiovascular Computed Tomography (SCCT) announced the publication of an analysis showing that cardiac CT is an accurate, noninvasive diagnostic test for obstructive coronary artery disease (CAD). Additionally, investigators from the DISCHARGE Trial Group found that cardiac CT poses less risk than the current standard diagnostic test for intermediate-risk patients of invasive coronary angiography (ICA), or cardiac catheterization. CT patients experienced significantly less major procedure-related complications over 3.5 years of follow-up.

According to the SCCT press release, the DISCHARGE randomized trial included a 31-institution consortium led by Professor Marc Dewey, MD. Prof. Dewey is head of the Department of Radiology on Campus Charité Mitte in Berlin, Germany. The DISCHARGE investigators compared the effectiveness of cardiac CT versus ICA as the initial diagnostic imaging strategy for evaluating stable patients with chest pain.

“CT or Invasive Coronary Angiography in Stable Chest Pain” by the DISCHARGE Trial Group, which is composed of Pál Maurovich-Horvat, MD, et al, is available online in The New England Journal of Medicine.

As summarized by SCCT, the DISCHARGE trial was composed of > 3,500 patients reporting chest pain who were randomly assigned to CT or ICA as a diagnostic imaging technique.

Clinical outcomes were similar for both test groups in the study, with 2.1% of patients in the cardiac CT group and 3% in the ICA group experiencing primary outcomes in major adverse cardiovascular events (MACE). The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke over 3.5 years.

Key secondary outcomes were major procedure-related complications and self-reported angina. Although MACE risks were similar in both groups, the frequency for major procedure-related complications was lower for patients in the CT group (0.5%) than for patients who underwent ICA (1.9%).

As noted by SCCT, CAD is associated with a reduced blood flow in the coronary arteries that supply the heart with oxygen and can lead to symptoms of chest pain and shortness of breath. Because approximately 60% of patients who are referred for ICA do not have obstructive CAD, this trial proves CT is a viable low-risk alternative to the invasive procedure, concluded the SCCT press release.