Details

Autor(en) / Beteiligte

• SHAW, Leslee J
• HAUSLEITER, Jörg
• CHENG, Victor Y
• CHOW, Benjamin J. W
• CURY, Ricardo C
• DELAGO, Augustin J
• DUNNING, Allison L
• FEUCHTNER, Gudrun M
• HADAMITZKY, Martin
• KARLSBERG, Ronald P
• KAUFMANN, Philipp A
• LEIPSIC, Jonathon
• ACHENBACH, Stephan
• LIN, Fay Y
• CHINNAIYAN, Kavitha M
• MAFFEI, Erica
• RAFF, Gilbert L
• VILLINES, Todd C
• LABOUNTY, Troy
• GOMEZ, Millie J
• MIN, James K
• AL-MALLAH, Mouaz
• BERMAN, Daniel S
• BUDOFF, Matthew J
• CADEMARTIRI, Fillippo
• CALLISTER, Tracy Q
• CHANG, Hyuk-Jae
• KIM, Yong-Jin

Titel

Coronary Computed Tomographic Angiography as a Gatekeeper to Invasive Diagnostic and Surgical Procedures: Results From the Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) Registry

Ist Teil von

• Journal of the American College of Cardiology, 2012-11, Vol.60 (20), p.2103-2114

Ort / Verlag

New York, NY: Elsevier

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA). CCTA is a noninvasive test that permits direct visualization of the extent and severity of coronary artery disease (CAD). Post-CCTA patterns of follow-up ICA and REV are incompletely defined. We examined 15,207 intermediate likelihood patients from 8 sites in 6 countries; these patients were without known CAD, underwent CCTA, and were followed up for 2.3 ± 1.2 years for all-cause mortality. Coronary artery stenosis was judged as obstructive when ≥50% stenosis was present. A multivariable logistic regression was used to estimate ICA use. A Cox proportional hazards model was used to estimate all-cause mortality. During follow-up, ICA rates for patients with no CAD to mild CAD according to CCTA were low (2.5% and 8.3%), with similarly low rates of REV (0.3% and 2.5%). Most ICA procedures (79%) occurred ≤3 months of CCTA. Obstructive CAD was associated with higher rates of ICA and REV for 1-vessel (44.3% and 28.0%), 2-vessel (53.3% and 43.6%), and 3-vessel (69.4% and 66.8%) CAD, respectively. For patients with <50% stenosis, early ICA rates were elevated; over the entirety of follow-up, predictors of ICA were mild left main, mild proximal CAD, respectively, or higher coronary calcium scores. In patients with <50% stenosis, the relative hazard for death was 2.2 (p = 0.011) for ICA versus no ICA. Conversely, for patients with CAD, the relative hazard for death was 0.61 for ICA versus no ICA (p = 0.047). These findings support the concept that CCTA may be used effectively as a gatekeeper to ICA.