Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-,intermediate- and high-risk coronary artery disease: results from the CONFIRM long-termregistry

• Type of Material: Article
• Authors: Joshua Schulman-Marcus, Albany Medical College; Fay Y. Lin, Weill Cornell Medical College; Heidi Gransar, Cedars-Sinai Medical Center; Daniel Berman, Cedars-Sinai Medical Center; Tracy Callister, Tennessee Heart and Vascular Institute; Augustin DeLago, Capital Cardiology Associates; Martin Hadamitzky, Deutsches Herzzentrum Munchen; Joerg Hausleiter, Deutsches Herzzentrum Munchen; Mouaz Al-Mallah, King Abdullah International Medical Research Center; Matthew Budoff, Harbor UCLA Medical Center; Philipp Kaufmann, University Hospital, Zurich; Stephan Achenbach, University of Erlangen; Gilbert Raff, William Beaumont Hospital; Kavitha Chinnaiyan, Giovanni XXIII Hospital; Filippo Cademartiri, Giovanni XXIII Hospital; Erica Maffei, Giovanni XXIII Hospital; Todd Villines, Walter Reed Medical Center; Yong-Jin Kim, Seoul National University Hospital; Jonathon Leipsic, University of British Columbia; Gudrun Feuchtner, Medical University of Innsbruck; Ronen Rubinshtein, Technion-Israel Institute of Technology; Gianluca Pontone, University of Milan; Daniele Andreini, University of Milan; Hugo Marques, Curry Cabral Hospital; Hyuk-Jae Chang, Severance Cardiovascular Hospital; Benjamin J.W. Chow, University of Ottawa; Ricardo C. Cury, Baptist Cardiac and Vascular Institute; Allison Dunning, Duke Clinical Research Institute; Leslee J Shaw, Emory University; James K. Min, Weill Cornell Medical College
• Language: English
• Date: 2017-08-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ehjci/jew287
• Title of Journal or Parent Work: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
• ISSN: 2047-2404
• Volume: 18
• Issue: 8
• Start Page: 841
• End Page: +
• Grant/Funding Information: Research reported in this publication was supported by the Heart Lung and Blood Institute of the National Institutes of Health (Bethesda, MD) under award number R01 HL115150, and funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging (New York, NY) and the Michael Wolk Foundation (New York, NY).
• Keywords: Radiology, Nuclear Medicine & Medical Imaging; CAD; CLINICAL-OUTCOMES; INTERVENTION; Life Sciences & Biomedicine; OUTCOMES UTILIZING REVASCULARIZATION; ANATOMY; Cardiac & Cardiovascular Systems; COURAGE TRIAL; CT ANGIOGRAPHY; coronary-computed tomographic angiography; Science & Technology; Cardiovascular System & Cardiology; BENEFIT; INTERNATIONAL MULTICENTER REGISTRY; SURGERY; revascularization; SURVIVAL
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

Aims To identify the effect of early revascularization on 5-year survival in patients with CAD diagnosed by coronarycomputed tomographic angiography (CCTA). Methods and results We examined 5544 stable patients with suspected CAD undergoing CCTA who were followed a median of 5.5 years in a large international registry. Patients were categorized as having low-, intermediate-, or high-risk CAD based on CCTA findings. Two treatment groups were defined: early revascularization within 90 days of CCTA (n = 1171) and medical therapy (n = 4373). To account for the non-randomized referral to revascularization, we developed a propensity score by logistic regression. This score was incorporated into Cox proportional hazard models to calculate the effect of revascularization on all-cause mortality. Death occurred in 363 (6.6%) patients and was more frequent in medical therapy. In multivariable models, when compared with medical therapy, the mortality benefit of revascularization varied significantly over time and by CAD risk (P for interaction 0.04). In high-risk CAD, revascularization was significantly associated with lower mortality at 1 year (hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.11-0.47) and 5 years (HR 0.31, 95% CI 0.18-0.54). For intermediate-risk CAD, revascularization was associated with reduced mortality at 1 year (HR 0.45, 95% CI 0.22-0.93) but not 5 years (HR 0.63, 95% CI 0.33-1.20). For low-risk CAD, there was no survival benefit at either time point. Conclusions Early revascularization was associated with reduced 1-year mortality in intermediate-and high-risk CAD detected by CCTA, but this association only persisted for 5-year mortality in high-risk CAD.