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

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

Keywords

  • CAD
  • Coronary-computed tomographic angiography
  • Revascularization

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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