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

Leslee J. Shaw, Jörg Hausleiter, Stephan Achenbach, Mouaz Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Fillippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Yong Jin Kim, Victor Y. Cheng, Benjamin J.W. Chow, Ricardo C. Cury, Augustin J. Delago, Allison L. Dunning, Gudrun M. Feuchtner, Martin Hadamitzky, Ronald P. Karlsberg, Philipp A. Kaufmann, Jonathon LeipsicFay Y. Lin, Kavitha M. Chinnaiyan, Erica Maffei, Gilbert L. Raff, Todd C. Villines, Troy Labounty, Millie J. Gomez, James K. Min

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

Objectives: This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA). Background: 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. Methods: 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. Results: 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). Conclusions: These findings support the concept that CCTA may be used effectively as a gatekeeper to ICA.

Original languageEnglish (US)
Pages (from-to)2103-2114
Number of pages12
JournalJournal of the American College of Cardiology
Volume60
Issue number20
DOIs
StatePublished - Nov 13 2012
Externally publishedYes

Keywords

  • coronary computed tomography
  • health services research
  • prognosis
  • resource utilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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