CT Preferred Treatment for Younger Cardiac Patients - EMJ

CT Preferred Treatment for Younger Cardiac Patients

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NEW research has shown that CT may be the preferred method for treating obstructive coronary artery disease (CAD) in younger patients. Invasive coronary angiography (ICA) has been the established treatment method for CAD for some time; however, coronary CT is a non-invasive alternative for ruling out obstructive CAD in patients with stable chest pain. Few prior studies have focused on the role of age in deciding between the two treatment methods.

The research team, led by the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) Trial Group, carried out the randomised trial between October 2015–April 2019 across 26 European centres. The team analysed patients with stable chest pain and an intermediate probability of obstructive CAD, who had been referred for ICA. Overall, 3,561 patients (mean [SD] age: 60.1 [10.1] years; 2,002 female [56.2%]) were included. Of these, 2,360 (66.3%) were younger than 65 years, 982 (27.6%) were between ages 65–75, and 219 (6.1%) were older than 75 years. The patients were randomly placed into CT or ICA groups.

Results demonstrated that modelling age as a continuous variable, age, and randomisation group were not associated with major adverse cardiovascular events (hazard ratio: 1.02; 95% confidence interval: 0.98–1.07). Age and randomisation group were associated with major procedure-related complications (odds ratio: 1.15; 95% confidence interval: 1.05–1.27). Ultimately, the findings showed that CT was linked to a lower risk of major procedure-related complications in patients younger than 65 years old.

The team concluded that though age did not modify the effect of randomisation on the primary outcome of major adverse cardiovascular events, it did alter the effect of major procedure-related complications. As a result, CT may be the preferred method of treatment for younger patients with obstructive CAD as opposed to ICA, due to the lower risk of major procedure-related complications in patients under 65.

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