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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.
J Am Coll Cardiol. 2012 Nov 13; 60(20):2103-14.JACC

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.

Authors+Show Affiliations

Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. leslee.shaw@emory.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23083780

Citation

Shaw, Leslee J., et al. "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." Journal of the American College of Cardiology, vol. 60, no. 20, 2012, pp. 2103-14.
Shaw LJ, Hausleiter J, Achenbach S, et al. 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. J Am Coll Cardiol. 2012;60(20):2103-14.
Shaw, L. J., Hausleiter, J., Achenbach, S., Al-Mallah, M., Berman, D. S., Budoff, M. J., Cademartiri, F., Callister, T. Q., Chang, H. J., Kim, Y. J., Cheng, V. Y., Chow, B. J., Cury, R. C., Delago, A. J., Dunning, A. L., Feuchtner, G. M., Hadamitzky, M., Karlsberg, R. P., Kaufmann, P. A., ... Min, J. K. (2012). 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. Journal of the American College of Cardiology, 60(20), 2103-14. https://doi.org/10.1016/j.jacc.2012.05.062
Shaw LJ, et al. 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. J Am Coll Cardiol. 2012 Nov 13;60(20):2103-14. PubMed PMID: 23083780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Shaw,Leslee J, AU - Hausleiter,Jörg, AU - Achenbach,Stephan, AU - Al-Mallah,Mouaz, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Cademartiri,Fillippo, AU - Callister,Tracy Q, AU - Chang,Hyuk-Jae, AU - Kim,Yong-Jin, AU - Cheng,Victor Y, AU - Chow,Benjamin J W, AU - Cury,Ricardo C, AU - Delago,Augustin J, AU - Dunning,Allison L, AU - Feuchtner,Gudrun M, AU - Hadamitzky,Martin, AU - Karlsberg,Ronald P, AU - Kaufmann,Philipp A, AU - Leipsic,Jonathon, AU - Lin,Fay Y, AU - Chinnaiyan,Kavitha M, AU - Maffei,Erica, AU - Raff,Gilbert L, AU - Villines,Todd C, AU - Labounty,Troy, AU - Gomez,Millie J, AU - Min,James K, AU - ,, Y1 - 2012/10/17/ PY - 2012/04/21/received PY - 2012/05/01/accepted PY - 2012/10/23/entrez PY - 2012/10/23/pubmed PY - 2013/1/30/medline SP - 2103 EP - 14 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 60 IS - 20 N2 - 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23083780/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(12)04231-3 DB - PRIME DP - Unbound Medicine ER -