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European Radiology
Published in: European Radiology 7/2017

01-07-2017 | Computed Tomography

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial

Authors: Adriane E. Napp, Robert Haase, Michael Laule, Georg M. Schuetz, Matthias Rief, Henryk Dreger, Gudrun Feuchtner, Guy Friedrich, Miloslav Špaček, Vojtěch Suchánek, Klaus Fuglsang Kofoed, Thomas Engstroem, Stephen Schroeder, Tanja Drosch, Matthias Gutberlet, Michael Woinke, Pál Maurovich-Horvat, Béla Merkely, Patrick Donnelly, Peter Ball, Jonathan D. Dodd, Martin Quinn, Luca Saba, Maurizio Porcu, Marco Francone, Massimo Mancone, Andrejs Erglis, Ligita Zvaigzne, Antanas Jankauskas, Gintare Sakalyte, Tomasz Harań, Malgorzata Ilnicka-Suckiel, Nuno Bettencourt, Vasco Gama-Ribeiro, Sebastian Condrea, Imre Benedek, Nada Čemerlić Adjić, Oto Adjić, José Rodriguez-Palomares, Bruno Garcia del Blanco, Giles Roditi, Colin Berry, Gershan Davis, Erica Thwaite, Juhani Knuuti, Mikko Pietilä, Cezary Kępka, Mariusz Kruk, Radosav Vidakovic, Aleksandar N. Neskovic, Ignacio Díez, Iñigo Lecumberri, Jacob Geleijns, Christine Kubiak, Anke Strenge-Hesse, The-Hoang Do, Felix Frömel, Iñaki Gutiérrez-Ibarluzea, Gaizka Benguria-Arrate, Hans Keiding, Christoph Katzer, Jacqueline Müller-Nordhorn, Nina Rieckmann, Mario Walther, Peter Schlattmann, Marc Dewey, The DISCHARGE Trial Group

Published in: European Radiology | Issue 7/2017

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Abstract

Objectives

More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266).

Methods

In this trial, patients with a low-to-intermediate pretest probability (10–60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines.

Results

Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences.

Conclusions

The DISCHARGE trial will assess the comparative effectiveness of CT and ICA.

Key Points

• Coronary artery disease (CAD) is a major cause of morbidity and mortality.
• Invasive coronary angiography (ICA) is the reference standard for detection of CAD.
• Noninvasive computed tomography angiography excludes CAD with high sensitivity.
• CT may effectively reduce the approximately 2 million negative ICAs in Europe.
• DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.
Appendix
Available only for authorised users
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Metadata
Title
Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial
Authors
Adriane E. Napp
Robert Haase
Michael Laule
Georg M. Schuetz
Matthias Rief
Henryk Dreger
Gudrun Feuchtner
Guy Friedrich
Miloslav Špaček
Vojtěch Suchánek
Klaus Fuglsang Kofoed
Thomas Engstroem
Stephen Schroeder
Tanja Drosch
Matthias Gutberlet
Michael Woinke
Pál Maurovich-Horvat
Béla Merkely
Patrick Donnelly
Peter Ball
Jonathan D. Dodd
Martin Quinn
Luca Saba
Maurizio Porcu
Marco Francone
Massimo Mancone
Andrejs Erglis
Ligita Zvaigzne
Antanas Jankauskas
Gintare Sakalyte
Tomasz Harań
Malgorzata Ilnicka-Suckiel
Nuno Bettencourt
Vasco Gama-Ribeiro
Sebastian Condrea
Imre Benedek
Nada Čemerlić Adjić
Oto Adjić
José Rodriguez-Palomares
Bruno Garcia del Blanco
Giles Roditi
Colin Berry
Gershan Davis
Erica Thwaite
Juhani Knuuti
Mikko Pietilä
Cezary Kępka
Mariusz Kruk
Radosav Vidakovic
Aleksandar N. Neskovic
Ignacio Díez
Iñigo Lecumberri
Jacob Geleijns
Christine Kubiak
Anke Strenge-Hesse
The-Hoang Do
Felix Frömel
Iñaki Gutiérrez-Ibarluzea
Gaizka Benguria-Arrate
Hans Keiding
Christoph Katzer
Jacqueline Müller-Nordhorn
Nina Rieckmann
Mario Walther
Peter Schlattmann
Marc Dewey
The DISCHARGE Trial Group
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4620-z

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