CT or Invasive Coronary Angiography in Stable Chest Pain

被引：203

作者：

Maurovich-Horvat, Pal ^{[1
,2
]}

Bosserdt, Maria ^{[3
]}

Kofoed, Klaus F. ^{[17
,18
,19
]}

Rieckmann, Nina ^{[5
]}

Benedek, Theodora ^{[23
,25
]}

Donnelly, Patrick ^{[27
,46
]}

Rodriguez-Palomares, Jose ^{[36
,38
]}

Erglis, Andrejs ^{[43
,45
]}

Stechovsk, Cyril

Sakalyte, Gintare ^{[48
,49
]}

Adic, Nada Cemerlic ^{[50
]}

Gutberlet, Matthias ^{[12
]}

Dodd, Jonathan D. ^{[53
,55
]}

Diez, Ignacio ^{[39
]}

Davis, Gershan ^{[28
,33
]}

Zimmermann, Elke ^{[3
]}

Kepka, Cezary ^{[56
]}

Vidakovic, Radosav ^{[51
,52
]}

Francone, Marco ^{[60
,61
]}

Ilnicka-Suckiel, Malgorzata ^{[57
]}

Plank, Fabian ^{[46
,64
,65
,68
]}

Knuuti, Juhani ^{[67
]}

Faria, Rita ^{[71
]}

Schroder, Stephen ^{[14
,48
,49
]}

Berry, Colin ^{[34
,35
]}

Saba, Luca ^{[62
]}

Ruzsics, Balazs ^{[30
,31
]}

Kubiak, Christine ^{[72
]}

Gutierrez-Ibarluzea, Inaki ^{[41
,42
]}

Hansen, Kristian Schultz ^{[20
]}

Muller-Nordhorn, Jacqueline ^{[5
,15
]}

Merkely, Bela ^{[1
]}

Knudsen, Andreas D. ^{[17
,18
,19
]}

Benedek, Imre ^{[26
]}

Orr, Clare ^{[27
]}

Valente, Filipa Xavier ^{[36
,38
]}

Zvaigzne, Ligita ^{[44
]}

Suchanek, Vojtech ^{[47
]}

Zajanckauskiene, Laura ^{[48
,49
]}

Adic, Flip ^{[50
]}

Woinke, Michael ^{[13
,48
,49
]}

Hensey, Mark ^{[54
]}

Lecumberri, Inigo ^{[40
]}

Thwaite, Erica ^{[29
]}

Laule, Michael ^{[4
]}

Kruk, Mariusz ^{[56
]}

Neskovic, Aleksandar N. ^{[51
,52
]}

Mancone, Massimo ^{[59
]}

Feuchtner, Gudrun ^{[66
]}

Kugrnierz, Donata ^{[58
]}

机构：

[1] Semmelweis Univ, Heart & Vasc Ctr, Budapest, Hungary

[2] Semmelweis Univ, Med Imaging Ctr, Dept Radiol, Budapest, Hungary

[3] Charite Univ Med Berlin, Dept Radiol, Charitepl 1, D-10117 Berlin, Germany

[4] Charite Univ Med Berlin, Dept Cardiol & Angiol, Berlin, Germany

[5] Charite Univ Med Berlin, Inst Publ Hlth, Berlin, Germany

[6] Charite Univ Med Berlin, Inst Biometry & Clin Epidemiol, Berlin, Germany

[7] Free Univ Berlin, Berlin, Germany

[8] Humboldt Univ, Berlin, Germany

[9] DZHK German Ctr Cardiovasc Res, Partner Site Berlin, Berlin, Germany

[10] Berlin Inst Hlth, Berlin, Germany

[11] Berlin Univ Alliance, Berlin, Germany

[12] Univ Leipzig Heart Ctr, Dept Radiol, Leipzig, Germany

[13] Univ Leipzig Heart Ctr, Dept Cardiol, Leipzig, Germany

[14] Alb Fils Kliniken, Dept Cardiol, Goppingen, Germany

[15] Bavarian Hlth & Food Safety Author, Bavarian Canc Registry, Munich, Germany

[16] Univ Klinikum Tubingen, Dept Clin Epidemiol & Appl Biostat, Tubingen, Germany

[17] Univ Copenhagen, Rigshosp, Dept Cardiol, Copenhagen, Denmark

[18] Univ Copenhagen, Rigshosp, Dept Radiol, Copenhagen, Denmark

[19] Univ Copenhagen, Fac Hlth & Med Sci, Dept Clin Med, Copenhagen, Denmark

[20] Univ Copenhagen, Dept Publ Hlth, Sect Hlth Serv Res, Copenhagen, Denmark

[21] Herlev Gentofte Hosp, Dept Cardiol, Hellerup, Denmark

[22] Nordsjaellands Hosp, Dept Cardiol, Hillerod, Denmark

[23] George Emil Palade Univ Med Pharm Sci & Technol, Dept Internal Med, Clin Cardiol, Targu Mures, Romania

[24] George Emil Palade Univ Med Pharm Sci & Technol, Dept Radiol & Med Imaging, Targu Mures, Romania

[25] George Emil Palade Univ Med Pharm Sci & Technol, Cty Clin Emergency Hosp Targu Mures, Targu Mures, Romania

[26] CardioMed Med Ctr, Ctr Adv Res Multimodal Cardiac Imaging, Targu Mures, Romania

[27] Southeastern Hlth & Social Care Trust, Dept Cardiol, Belfast, Antrim, North Ireland

[28] Aintree Univ Hosp NHS Fdn Trust, Dept Cardiol, Liverpool, Merseyside, England

[29] Aintree Univ Hosp NHS Fdn Trust, Dept Radiol, Liverpool, Merseyside, England

[30] Royal Liverpool Univ Hosp, Dept Cardiol, Liverpool, Merseyside, England

[31] Liverpool Heart & Chest Hosp, Inst Cardiovasc Med & Sci, Liverpool, Merseyside, England

[32] Univ Liverpool, Fac Hlth & Life Sci, Liverpool, Merseyside, England

[33] Edge Hill Univ, Ormskirk, England

[34] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[35] Golden Jubilee Natl Hosp, Clydebank, Scotland

[36] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Inst Recerca, Dept Cardiol, Barcelona, Spain

[37] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Inst Recerca, Dept Radiol, Barcelona, Spain

[38] Ctr Invest Biomed Red, Madrid, Spain

[39] Basurto Hosp, Dept Cardiol, Bilbao, Spain

[40] Basurto Hosp, Dept Radiol, Bilbao, Spain

[41] Basque Fdn Hlth Innovat & Res, Baracaldo, Spain

[42] Basque Off Hlth Technol Assessment, Vitoria, Spain

[43] Paul Stradins Clin Univ Hosp, Dept Cardiol, Riga, Latvia

[44] Paul Stradins Clin Univ Hosp, Dept Radiol, Riga, Latvia

[45] Univ Latvia, Riga, Latvia

[46] Motol Univ Hosp, Dept Cardiol, Prague, Czech Republic

[47] Motol Univ Hosp, Dept Imaging Methods, Prague, Czech Republic

[48] Lithuanian Univ Hlth Sci, Med Acad, Dept Cardiol, Kaunas, Lithuania

[49] Hosp Lithuanian Univ Hlth Sci, Dept Cardiol, Kaunas, Lithuania

[50] Univ Novi Sad, Fac Med, Novi Sad, Serbia

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2022年 / 386卷 / 17期

关键词：

GUIDELINES; MANAGEMENT; ANGINA; PCI;

D O I：

10.1056/NEJMoa2200963

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD), computed tomography (CT) is an accurate, noninvasive alternative to invasive coronary angiography (ICA). However, the comparative effectiveness of CT and ICA in the management of CAD to reduce the frequency of major adverse cardiovascular events is uncertain. METHODS We conducted a pragmatic, randomized trial comparing CT with ICA as initial diagnostic imaging strategies for guiding the treatment of patients with stable chest pain who had an intermediate pretest probability of obstructive CAD and were referred for ICA at one of 26 European centers. The primary outcome was major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) over 3.5 years. Key secondary outcomes were procedure-related complications and angina pectoris. RESULTS Among 3561 patients (56.2% of whom were women), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95% confidence interval [CI), 0.46 to 1.07; P=0.10). Major procedure-related complications occurred in 9 patients (0.5%) in the CT group and in 33 (1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final 4 weeks of follow-up was reported in 8.8% of the patients in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). CONCLUSIONS Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure-related complications was lower with an initial CT strategy.

引用

页码：1591 / 1602

页数：12

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