Computed Tomography vs. Invasive Angiography in Stable Chest Pain: Does Patient Sex Matter?

In the multicenter, randomized (but nonblinded) DISCHARGE clinical trial (NCT02400229), major adverse cardiovascular events were similar with use of computed tomography angiography (CTA) or invasive coronary angiography (ICA) for initial evaluation of patients with stable chest pain and suspected coronary artery disease (CAD; NEJM JW Gen Med Apr 15 and N Engl J Med 2022; 386:1591). As some evidence suggests possible reduced accuracy of CTA in women in this setting, the investigators also examined sex-specific outcomes.

The prespecified analysis included 2002 men (56%) and 1559 women (44%) with chest pain and an estimated risk for obstructive CAD of 10%–60% who were randomized to an initial strategy of CTA or ICA. During a median follow-up of…