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Author Notes:

Corresponding author. Tel: þ646 962 6266; Fax: þ646 962 0129. E-mail: jkm2001@med.cornell.edu

The data presented in this article is original and has not been reported elsewhere, nor is this article under consideration with any other journal.

All cohort participants provided written informed consent, and the appropriate ethics committees approved the study.

J.K.M. reports being a consultant with HeartFlow, on the scientific advisory board of Arineta, having partial ownership in MDDX and Autoplaq, and receiving research support from GE Healthcare.

Conflict of interest: None declared.


Research Funding:

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).


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Radiology, Nuclear Medicine & Medical Imaging
  • Cardiovascular System & Cardiology
  • coronary-computed tomographic angiography
  • CAD
  • revascularization

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

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Journal Title:

EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging


Volume 18, Number 8


, Pages 841-+

Type of Work:

Article | Final Publisher PDF


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.

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© 2017 The Author.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/).

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