TY - JOUR
T1 - Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediateand high-risk coronary artery disease
T2 - Results from the CONFIRM long-term registry
AU - Schulman-Marcus, Joshua
AU - Lin, Fay Y.
AU - Gransar, Heidi
AU - Berman, Daniel
AU - Callister, Tracy
AU - DeLago, Augustin
AU - Hadamitzky, Martin
AU - Hausleiter, Joerg
AU - Al-Mallah, Mouaz
AU - Budoff, Matthew
AU - Kaufmann, Philipp
AU - Achenbach, Stephan
AU - Raff, Gilbert
AU - Chinnaiyan, Kavitha
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Villines, Todd
AU - Kim, Yong Jin
AU - Leipsic, Jonathon
AU - Feuchtner, Gudrun
AU - Rubinshtein, Ronen
AU - Pontone, Gianluca
AU - Andreini, Daniele
AU - Marques, Hugo
AU - Chang, Hyuk Jae
AU - Chow, Benjamin J.W.
AU - Cury, Ricardo C.
AU - Dunning, Allison
AU - Shaw, Leslee
AU - Min, James K.
N1 - Publisher Copyright:
© 2017 The Author.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - 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.
AB - 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.
KW - CAD
KW - Coronary-computed tomographic angiography
KW - Revascularization
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U2 - 10.1093/ehjci/jew287
DO - 10.1093/ehjci/jew287
M3 - Article
C2 - 28329294
AN - SCOPUS:85031496713
SN - 2047-2404
VL - 18
SP - 841
EP - 848
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 8
ER -