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Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial.

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Title: Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial.
Authors: Mancone, Massimo1 (AUTHOR), Mézquita, Aldo J. Vázquez2 (AUTHOR), Birtolo, Lucia Ilaria1 (AUTHOR), Maurovich-Horvat, Pal3,4 (AUTHOR), Kofoed, Klaus F.5,6 (AUTHOR), Benedek, Theodora7,8 (AUTHOR), Donnelly, Patrick9 (AUTHOR), Rodriguez-Palomares, Jose10,11 (AUTHOR), Erglis, Andrejs12,13 (AUTHOR), Štěchovský, Cyril14 (AUTHOR), Šakalytė, Gintare15,16 (AUTHOR), Ađić, Nada Čemerlić17,18 (AUTHOR), Gutberlet, Matthias19 (AUTHOR), Diez, Ignacio20 (AUTHOR), Davis, Gershan21,22 (AUTHOR), Zimmermann, Elke2 (AUTHOR), Kępka, Cezary23 (AUTHOR), Vidakovic, Radosav24,25 (AUTHOR), Francone, Marco26,27 (AUTHOR), Ilnicka-Suckiel, Małgorzata28 (AUTHOR)
Source: European Radiology. Jun2024, Vol. 34 Issue 6, p4127-4141. 15p.
Subjects: Coronary artery disease, Transient ischemic attack, Major adverse cardiovascular events, Coronary angiography, Smoking
Abstract: Objectives: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. Materials and methods: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). Results: Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. Conclusion: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. Clinical relevance statement: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. Trial registration: ClinicalTrials.gov NCT02400229. Key Points: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial.
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  Data: <searchLink fieldCode="AR" term="%22Mancone%2C+Massimo%22">Mancone, Massimo</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mézquita%2C+Aldo+J%2E+Vázquez%22">Mézquita, Aldo J. Vázquez</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Birtolo%2C+Lucia+Ilaria%22">Birtolo, Lucia Ilaria</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Maurovich-Horvat%2C+Pal%22">Maurovich-Horvat, Pal</searchLink><relatesTo>3,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kofoed%2C+Klaus+F%2E%22">Kofoed, Klaus F.</searchLink><relatesTo>5,6</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Benedek%2C+Theodora%22">Benedek, Theodora</searchLink><relatesTo>7,8</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Donnelly%2C+Patrick%22">Donnelly, Patrick</searchLink><relatesTo>9</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rodriguez-Palomares%2C+Jose%22">Rodriguez-Palomares, Jose</searchLink><relatesTo>10,11</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Erglis%2C+Andrejs%22">Erglis, Andrejs</searchLink><relatesTo>12,13</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Štěchovský%2C+Cyril%22">Štěchovský, Cyril</searchLink><relatesTo>14</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Šakalytė%2C+Gintare%22">Šakalytė, Gintare</searchLink><relatesTo>15,16</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ađić%2C+Nada+Čemerlić%22">Ađić, Nada Čemerlić</searchLink><relatesTo>17,18</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gutberlet%2C+Matthias%22">Gutberlet, Matthias</searchLink><relatesTo>19</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Diez%2C+Ignacio%22">Diez, Ignacio</searchLink><relatesTo>20</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Davis%2C+Gershan%22">Davis, Gershan</searchLink><relatesTo>21,22</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zimmermann%2C+Elke%22">Zimmermann, Elke</searchLink><relatesTo>2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kępka%2C+Cezary%22">Kępka, Cezary</searchLink><relatesTo>23</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Vidakovic%2C+Radosav%22">Vidakovic, Radosav</searchLink><relatesTo>24,25</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Francone%2C+Marco%22">Francone, Marco</searchLink><relatesTo>26,27</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ilnicka-Suckiel%2C+Małgorzata%22">Ilnicka-Suckiel, Małgorzata</searchLink><relatesTo>28</relatesTo> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Jun2024, Vol. 34 Issue 6, p4127-4141. 15p.
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  Data: <searchLink fieldCode="DE" term="%22Coronary+artery+disease%22">Coronary artery disease</searchLink><br /><searchLink fieldCode="DE" term="%22Transient+ischemic+attack%22">Transient ischemic attack</searchLink><br /><searchLink fieldCode="DE" term="%22Major+adverse+cardiovascular+events%22">Major adverse cardiovascular events</searchLink><br /><searchLink fieldCode="DE" term="%22Coronary+angiography%22">Coronary angiography</searchLink><br /><searchLink fieldCode="DE" term="%22Smoking%22">Smoking</searchLink>
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  Label: Abstract
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  Data: Objectives: To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. Materials and methods: This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). Results: Of 3445 randomised patients with smoking data (mean age 59.1 years + / − 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. Conclusion: For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. Clinical relevance statement: This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. Trial registration: ClinicalTrials.gov NCT02400229. Key Points: • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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