Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediateand high-risk coronary artery disease: Results from the CONFIRM long-term registry

Joshua Schulman-Marcus, Fay Y. Lin, Heidi Gransar, Daniel Berman, Tracy Callister, Augustin DeLago, Martin Hadamitzky, Joerg Hausleiter, Mouaz Al-Mallah, Matthew Budoff, Philipp Kaufmann, Stephan Achenbach, Gilbert Raff, Kavitha Chinnaiyan, Filippo Cademartiri, Erica Maffei, Todd Villines, Yong Jin Kim, Jonathon Leipsic, Gudrun FeuchtnerRonen Rubinshtein, Gianluca Pontone, Daniele Andreini, Hugo Marques, Hyuk Jae Chang, Benjamin J.W. Chow, Ricardo C. Cury, Allison Dunning, Leslee Shaw, James K. Min

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)841-848
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume18
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

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Registries
Coronary Artery Disease
Angiography
Mortality
Confidence Intervals
Therapeutics
Propensity Score
Survival
Proportional Hazards Models
Referral and Consultation
Logistic Models

Keywords

  • CAD
  • Coronary-computed tomographic angiography
  • Revascularization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediateand high-risk coronary artery disease : Results from the CONFIRM long-term registry. / Schulman-Marcus, Joshua; Lin, Fay Y.; Gransar, Heidi; Berman, Daniel; Callister, Tracy; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Al-Mallah, Mouaz; Budoff, Matthew; Kaufmann, Philipp; Achenbach, Stephan; Raff, Gilbert; Chinnaiyan, Kavitha; Cademartiri, Filippo; Maffei, Erica; Villines, Todd; Kim, Yong Jin; Leipsic, Jonathon; Feuchtner, Gudrun; Rubinshtein, Ronen; Pontone, Gianluca; Andreini, Daniele; Marques, Hugo; Chang, Hyuk Jae; Chow, Benjamin J.W.; Cury, Ricardo C.; Dunning, Allison; Shaw, Leslee; Min, James K.

In: European Heart Journal Cardiovascular Imaging, Vol. 18, No. 8, 01.08.2017, p. 841-848.

Research output: Contribution to journalArticle

Schulman-Marcus, J, Lin, FY, Gransar, H, Berman, D, Callister, T, DeLago, A, Hadamitzky, M, Hausleiter, J, Al-Mallah, M, Budoff, M, Kaufmann, P, Achenbach, S, Raff, G, Chinnaiyan, K, Cademartiri, F, Maffei, E, Villines, T, Kim, YJ, Leipsic, J, Feuchtner, G, Rubinshtein, R, Pontone, G, Andreini, D, Marques, H, Chang, HJ, Chow, BJW, Cury, RC, Dunning, A, Shaw, L & Min, JK 2017, 'Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediateand high-risk coronary artery disease: Results from the CONFIRM long-term registry', European Heart Journal Cardiovascular Imaging, vol. 18, no. 8, pp. 841-848. https://doi.org/10.1093/ehjci/jew287
Schulman-Marcus, Joshua ; Lin, Fay Y. ; Gransar, Heidi ; Berman, Daniel ; Callister, Tracy ; DeLago, Augustin ; Hadamitzky, Martin ; Hausleiter, Joerg ; Al-Mallah, Mouaz ; Budoff, Matthew ; Kaufmann, Philipp ; Achenbach, Stephan ; Raff, Gilbert ; Chinnaiyan, Kavitha ; Cademartiri, Filippo ; Maffei, Erica ; Villines, Todd ; Kim, Yong Jin ; Leipsic, Jonathon ; Feuchtner, Gudrun ; Rubinshtein, Ronen ; Pontone, Gianluca ; Andreini, Daniele ; Marques, Hugo ; Chang, Hyuk Jae ; Chow, Benjamin J.W. ; Cury, Ricardo C. ; Dunning, Allison ; Shaw, Leslee ; Min, James K. / Coronary revascularization vs. medical therapy following coronary-computed tomographic angiography in patients with low-, intermediateand high-risk coronary artery disease : Results from the CONFIRM long-term registry. In: European Heart Journal Cardiovascular Imaging. 2017 ; Vol. 18, No. 8. pp. 841-848.
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abstract = "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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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.

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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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