Imaging for chest pain: CT- and ICA-first strategies linked to similar long-term health status
When patients present with stable chest pain, starting with CT or a more invasive imaging procedure are associated with similar improvements in quality of life (QOL), according to new findings published in JAMA Cardiology.[1]
The study’s authors performed a new analysis of data from the DISCHARGE randomized clinical trial. DISCHARGE was developed to evaluate chest pain patients treated with CT or invasive coronary angiography (ICA) as the first imaging test of choice. Initial results from that trial showed that the two strategies were comparable in terms of major cardiac adverse events, though CT patients experienced fewer procedure-related complications. For this updated look at DISCHARGE, researchers hoped to examine the two imaging approaches in terms of health status.
“Compared with patients with no coronary artery disease (CAD), the presence of nonobstructive CAD increases the incidence of cardiac events and hospitalizations, and QOL remains at lower levels compared with the general population,” wrote corresponding author Jonathan D. Dodd, MD, with the department of radiology at St. Vincent’s University Hospital in Ireland, and colleagues. “Any clinical management strategy proposed for these patients thus needs to include an assessment of QOL and chest pain as key outcomes. Because QOL in females with stable chest pain has been reported to be lower than that in males, it is also important to consider possible sex differences in the impact of any interventions.”
The group monitored patient QOL using several common scoring systems. Overall, Dodd et al. found that there were no significant differences after three years between patients treated with a CT-first strategy and those treated with an ICA-first strategy when it came to QOL.
QOL was worse for women than men both at baseline and at follow-up, the group noted, but they did show greater improvements than men in some of the self-reported QOL scores being evaluated.
“This result is important for clinical practice because it informs the conversation between clinician and patient about which test to perform,” the authors wrote. “The clinician can tell the patient that the outcome they hope for is equally likely irrespective of which test they choose to undergo.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.