DISCHARGE is a collaborative multinational research project. The consortium of the project is composed of 30 members in 18 European states. Core of the project is a pragmatic randomised controlled trial which includes 26 clinical sites from 16 European countries. The project will examine for which patients with suspected coronary artery disease based on stable chest pain, cardiac computed tomography (CT) or cardiac catheterisation is best suited and is based on the single-centre experience with the CAD-Man study at Charité.
Coronary artery disease is the leading cause of death in high-income countries. It is associated with a reduced blood flow in the coronary arteries that supply the heart with oxygen. This reduced blood flow may cause symptoms of chest pain, shortness of breath as well as a decreased exercise tolerance and bears an increased risk for myocardial infarction.
Cardiac catheterisation is the reference standard for the diagnosis of coronary artery disease and allows immediate therapy. Currently each year more than 3.5 million cardiac catheterisations are performed in the European Union. Nearly 60 percent of these minimal invasive examinations, around 2 million, do not result in any further treatment, because the patients do not have obstructive epicardial coronary artery stenosis. In these cases, cardiac CT could be a viable alternative to catheterisation with additional benefits for the patient.
Cardiac CT is a non-invasive diagnostic method. The patient would be exposed to lower risks and the examination is less burdensome. Patients can undergo CT on an outpatient basis without the need to stay at the hospital. Additionally, cardiac CT allows the detection of plaques in the coronary arteries as well as other noncardiac conditions (e.g. aortic dissection, pulmonary artery embolism) that may be the reason for chest pain. This additional information may lead to modifications of the treatment, changes in medication and recommendations for risk factor modifications.
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 cardiac CT. The project is funded with six million Euros from the European Union. It started in February 2014 and will last for five years. It is coordinated by the Department of Radiology of Charité – Universitätsmedizin Berlin (coordinator: Prof. Dr. Marc Dewey).