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.
by
Yuka Otaki;
Reza Arsanjani;
Heidi Gransar;
Victor Y. Cheng;
Damni Dey;
Troy Labounty;
Fay Y. Lin;
Stephan Achenbach;
Mouaz Al-Mallah;
Matthew J. Budoff;
Flippo Cademartiri;
Tracy Q. Callister;
Hyuk-Jae Chang;
Kavitha Chinnaiyan;
Benjamin J. W. Chow;
Augustin Delago;
Martin Hadamitzky;
Joerg Hausleiter;
Philipp Kaufmann;
Erica Maffei;
Gibert Raff;
Leslee J Shaw;
Todd C. Villines;
Allison Dunning;
Ricardo C. Cury;
Gudrun Feuchtner;
Tong-Jin Kim;
Jonathon Leipsic;
Daniel S. Berman;
James K. Min
Coronary computed tomographic angiography (CCTA) employing CT scanners of 64-detector rows or greater represents a novel non-invasive method for detection of coronary artery disease (CAD), providing excellent diagnostic information when compared to invasive angiography. In addition to its high diagnostic performance, prior studies have shown that CCTA can provide important prognostic information, although these prior studies have been generally limited to small cohorts at single centers. The Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter registry, or CONFIRM, is a large, prospective, multinational, dynamic observational cohort study of patients undergoing CCTA. This registry currently represents more than 32,000 consecutive adults suspected of having CAD who underwent ≥64-detector row CCTA at 12 centers in 6 countries between 2005 and 2009. Based on its large sample size and adequate statistical power, the data derived from CONFIRM registry have and will continue to provide key answers to many important topics regarding CCTA. Based on its multisite international national design, the results derived from CONFIRM should be considered as more generalizable than prior smaller single-center studies. This article summarizes the current status of several studies from CONFIRM registry.