Scientists from 28 research facilities in 20 European countries met earlier this year to kick off the collaborative EU research project known as DISCHARGE, whose purpose is to determine for which patients with chest pain would cardiac CT be best indicated as opposed to cardiac catheterization.
Coronary artery disease (CAD) is the leading cause of death in high-income countries. Invasive coronary angiography (ICA) is the reference standard for the diagnosis of CAD and allows immediate therapy. However, only 40% of patients undergoing ICA actually have obstructive CAD and ICA has relatively rare but considerable risks. Coronary computed tomography (CT) is the most accurate diagnostic test for CAD currently available. CT may become the most effective strategy to reduce the approximately 2 million annual negative ICAs in Europe by enabling early and safe discharge of the majority of patients with an intermediate risk of CAD.
To evaluate this, the DISCHARGE project has been set up, to be carried out by a multinational European consortium. The core of the project is a pragmatic randomized controlled trial. The primary hypothesis will be that CT is superior to ICA for major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction and stroke) after a maximum follow-up of 4 years in a selected broad population of stable chest pain patients with intermediate pretest likelihood of CAD.
The trial will include 23 clinical sites from 18 European countries, thus ensuring broad geographical representation. Comparative effectiveness research of complementing work packages include gender-related analysis, systematic review of evidence, cost-effectiveness analysis, and health-related quality of life. DISCHARGE has the capability to influence current standards and guidelines as well as coverage decisions and will raise awareness among patients, health care providers and decision-makers in Europe about the effectiveness and cost-effectiveness of coronary CT angiography.
The DISCHARGE project received six million Euros of funding from the European Union for five years and is coordinated by Charité – Universitätsmedizin Berlin under the leadership of Prof. Marc Dewey of the Department of Radiology at the Charité hospital in Berlin. “Given the broad scope of our DISCHARGE collaborative research, we expect to achieve conclusive results, which will directly impact practice in cardiovascular medicine. We very much hope that our findings can contribute to improving medical care for cardiac patients”, commented Prof. Dewey at the start of the project.