Document is current

Article History

Received: 7 June 2023

Revised: 24 August 2023

Accepted: 28 August 2023

First Online: 22 November 2023

Declarations

:

: The scientific guarantor of this publication is Professor Marc Dewey.

: B Merkely received a grant from Biotronik, Medtronic, and Abbott (personal fees). He additionally received a grant from Boston Scientific.K. Kofoed received grants from AP Møller og hustru Chastine McKinney Møllers Fond, Danish Heart Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research, and Health Insurance Company Denmark. He additionally received an unrestricted research grant from Canon Medical Corporation and GE Healthcare.H Theodora received grants from Romanian Ministry of European Funds, the Romanian Government, and the European Union (Increasing the research capacity in the field of vulnerable plaque imaging, based on advanced nanoparticles, fusion imaging and computational simulation – PlaqueImage” nt no. 103544/2016, contract number 26/01.09.2016).E Zimmermann received grants from Deutsche Forschungsgemeinschaft (Grant: Radiomics in SPP 2177/1).M Francone is <i>European Radiology</i>’s section editor of Cardiac in the Scientific editorial board. He has not taken part in the review or selection process of this article.J Knuuti received grants from AstraZeneca (personal fees: study protocol review) and from GE Healthcare (personal fees: study protocol review). He received payments for lectures from GE Healthcare, Merck, Lundbeck and Bayer (speaker’s fee), and Boehringer-Ingelheim, Pfizer (speaker’s fee). He reported other financial or non-financial interests for European Society of Cardiology (Dr. Knuuti is Chair of the European Society of Cardiology guidelines on chronic coronary syndrome. The work is on a voluntary basis and only remuneration of travel expenses occurs).C Berry received grants from AstraZeneca (grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment);Abbott Vascular: grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment;GSK: grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment;HeartFlow: grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment;Menarini: grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment;Novartis: grant and other: The University of Glasgow has received funding for research and consultancy work in the field of ischaemic heart disease undertaken by Colin Berry in the course of his employment;Siemens: other: The University of Glasgow has research agreements in the field of ischaemic heart disease for work undertaken by Colin Berry in the course of his employment;British Heart Foundation: whereby the University of Glasgow received research funding from The British Heart Foundation RE/18/6134217;N Rieckmann received a grant from the German Ministry of Education and Research (NAVICARE 01GY1911; PI of Grant (not own salary).I Benedek received a grant from Romanian Ministry of European Funds the Romanian Government and the European Union (Increasing the research capacity in the field of vulnerable plaque imaging, based on advanced nanoparticles, fusion imaging and computational simulation – PlaqueImage nt no. 103544/2016, contract number 26/01.09.2016).M Rief received a grant from Deutsche Forschungsgemeinschaft (Grant: Radiomics in SPP 2177/1).M Kruk received a grant from National Science Center (Poland) (payment to the institution). He reported patents for EP3157444B1 (granted); WO2015193847A1 (pending); WO2013060883A4 (pending).PS Douglas has received funding from HeartFlow for research in the field of ischaemic heart disease undertaken by Professor Douglas in the course of her employment. She received honoraria from Wolter Kluwers for medical education writing.PE Sigvardsen reports consulting fees from Novo Nordisk (consulting fees outside the submitted work).G. Šakalytė received payments for lectures from Amgen (Clinical Financial Service), Astra Zeneca (Novartis Baltics), Bayer (Sanofi Aventis), Berlin Chemie Menarini, Baltic (Servier Pharma), and IQVIA. G Šakalytė reported support from Servier and Novartis for travel to scientific meetings. He reported being a member of Lithuanian Society of Cardiology (Fellow of the ESC); Lithuanian Heart Association; Lithuanian Hypertension Society. He reported participation on a Data and Safety Monitoring Board in Boehringer Ingelheim.M Gutbelet received payments for lectures from Bayer (institution), Siemens (institution), Bracco (institution), and German Roentgen Society (DRG) (institution). He reported being a Member of Scientific Committee of the ESCR (unpaid); member of the Committee of the Working Group on Cardiovascular Imaging of the German Roentgen Society (DRG) (unpaid).P Maurovich-Horvat reported Neumann Medical Ltd. as a shareholder.C Delles reported other financial or non-financial interests from the British Heart Foundation (The University of Glasgow received research funding from The British Heart Foundation RE/18/6134217).JD Dodd is an Associate Editor for <i>Radiology</i>, a member of the Editorial Board for Radiology Cardiothoracic Imaging, and an Associate Editor for the <i>Quarterly Journal of Medicine</i>. All non-paid. He is a co-author of book chapters in the Stat-Dx book Series Diagnostic Imaging – Cardiovascular and the textbook CT and MRI in Cardiology, Elsevier.M Dewey received grant support from the German Research Foundation (DFG) in the Heisenberg Program (DE 1361/14–1, DFG project number: 213705389), for fractal analysis of myocardial perfusion (DE 1361/18–1, DFG project number: 392304398), the GUIDE-IT project on data sharing of medi cal imaging trials (DE 1361/24–1 [DFG project number: 495697118]), the Quantitative Cardiovascular Imaging (QCI) meeting (DE 1361/22–1), and the Future of Medical Imaging meeting (DE 1361/28–1). He also received funding from the Berlin University Alliance (GC_SC_PC 27) and from the Digital Health Accelerator of the Berlin Institute of Health. Lectures: Canon, Guerbet. Editor: Cardiac CT (Springer Nature). Hands-on car diac CT courses (www. ct-.kurs. de); institutional research agreements: Siemens, General Electric, Philips, Canon. M Dewey is European Society of Radiology (ESR) Publications Chair (2022-2025); and the opinions expressed in this article are the author’s own and do not represent the view of ESR. Per the guiding principles of ESR, the work as Publications Chair is on a voluntary basis and only remuneration of travel expenses occurs. All other authors report no other conflicts exist.

: Lina M. Serna-Higuita and Peter Martus kindly provided statistical advice for this manuscript.

: Written informed consent was obtained from all subjects (patients) in this study.

: Institutional Review Board approval was obtained from all sites. This study was approved by the ethics committee at Charité–Universitätsmedizin Berlin as the coordinating centre, by the German Federal Office for Radiation Protection, and by local or national ethics committees of all sites.

: The patients in the current submission were recruited for the EU-funded pragmatic, randomised, multicentre DISCHARGE trial (NCT02400229, Eur Radiol. 2017 Jul;27(7):2957–2968) to assess the comparative effectiveness of CT and ICA in patients with stable chest pain clinically referred for ICA with an intermediate clinical pre-test probability of obstructive coronary artery disease. We randomly assigned 3667 patients at 26 clinical centres in 16 European countries to a CT-first or an ICA-first strategy. The main results were published in the NEJM in April 2022 (NEJM 2022 386(17): 1591–1602).A pre-specified subgroup analysis not included in the main DISCHARGE trial outcome paper published in the NEJM was to evaluate the impact of smoking status on the effectiveness of CT vs ICA in symptomatic patients referred for ICA. Herein, we submit the results of this pre-specified subgroup analysis.

: • prospective• randomised controlled trial• multicentre study