All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography: Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry)

James K. Min, Daniel S. Berman, Allison Dunning, Stephan Achenbach, Mouaz Al-Mallah, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk-Jae Chang, Victor Cheng, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo Cury, Augustin Delago, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp Kaufmann, Ronald P. Karlsberg, Yong Jin KimJonathon Leipsic, Fay Y. Lin, Erica Maffei, Fabian Plank, Gilbert Raff, Todd Villines, Troy M. Labounty, Leslee J. Shaw

Research output: Contribution to journalArticle

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Abstract

Aims To date, the therapeutic benefit of revascularization vs. medical therapy for stable individuals undergoing invasive coronary angiography (ICA) based upon coronary computed tomographic angiography (CCTA) findings has not been examined.Methods and resultsWe examined 15 223 patients without known coronary artery disease (CAD) undergoing CCTA from eight sites and six countries who were followed for median 2.1 years (interquartile range 1.4-3.3 years) for an endpoint of all-cause mortality. Obstructive CAD by CCTA was defined as a ≥50% luminal diameter stenosis in a major coronary artery. Patients were categorized as having high-risk CAD vs. non-high-risk CAD, with the former including patients with at least obstructive two-vessel CAD with proximal left anterior descending artery involvement, three-vessel CAD, and left main CAD. Death occurred in 185 (1.2%) patients. Patients were categorized into two treatment groups: revascularization (n = 1103; 2.2% mortality) and medical therapy (n = 14 120, 1.1% mortality). To account for non-randomized referral to revascularization, we created a propensity score developed by logistic regression to identify variables that influenced the decision to refer to revascularization. Within this model (C index 0.92, χ2 = 1248, P < 0.0001), obstructive CAD was the most influential factor for referral, followed by an interaction of obstructive CAD with pre-test likelihood of CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization increased from 3.8% for non-high-risk CAD to 51.2% high-risk CAD. In multivariable models, when compared with medical therapy, revascularization was associated with a survival advantage for patients with high-risk CAD [hazards ratio (HR) 0.38, 95% confidence interval 0.18-0.83], with no difference in survival for patients with non-high-risk CAD (HR 3.24, 95% CI 0.76-13.89) (P-value for interaction = 0.03).ConclusionIn an intermediate-term follow-up, coronary revascularization is associated with a survival benefit in patients with high-risk CAD by CCTA, with no apparent benefit of revascularization in patients with lesser forms of CAD.

Original languageEnglish
Pages (from-to)3088-3097
Number of pages10
JournalEuropean heart journal
Volume33
Issue number24
DOIs
Publication statusPublished - 2012 Dec 1

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Coronary Angiography
Registries
Coronary Artery Disease
Angiography
Mortality
Therapeutics
Computed Tomography Angiography
Survival
Referral and Consultation
Propensity Score

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Min, James K. ; Berman, Daniel S. ; Dunning, Allison ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk-Jae ; Cheng, Victor ; Chinnaiyan, Kavitha ; Chow, Benjamin J.W. ; Cury, Ricardo ; Delago, Augustin ; Feuchtner, Gudrun ; Hadamitzky, Martin ; Hausleiter, Joerg ; Kaufmann, Philipp ; Karlsberg, Ronald P. ; Kim, Yong Jin ; Leipsic, Jonathon ; Lin, Fay Y. ; Maffei, Erica ; Plank, Fabian ; Raff, Gilbert ; Villines, Todd ; Labounty, Troy M. ; Shaw, Leslee J. / All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography : Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry). In: European heart journal. 2012 ; Vol. 33, No. 24. pp. 3088-3097.
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title = "All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography: Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry)",
abstract = "Aims To date, the therapeutic benefit of revascularization vs. medical therapy for stable individuals undergoing invasive coronary angiography (ICA) based upon coronary computed tomographic angiography (CCTA) findings has not been examined.Methods and resultsWe examined 15 223 patients without known coronary artery disease (CAD) undergoing CCTA from eight sites and six countries who were followed for median 2.1 years (interquartile range 1.4-3.3 years) for an endpoint of all-cause mortality. Obstructive CAD by CCTA was defined as a ≥50{\%} luminal diameter stenosis in a major coronary artery. Patients were categorized as having high-risk CAD vs. non-high-risk CAD, with the former including patients with at least obstructive two-vessel CAD with proximal left anterior descending artery involvement, three-vessel CAD, and left main CAD. Death occurred in 185 (1.2{\%}) patients. Patients were categorized into two treatment groups: revascularization (n = 1103; 2.2{\%} mortality) and medical therapy (n = 14 120, 1.1{\%} mortality). To account for non-randomized referral to revascularization, we created a propensity score developed by logistic regression to identify variables that influenced the decision to refer to revascularization. Within this model (C index 0.92, χ2 = 1248, P < 0.0001), obstructive CAD was the most influential factor for referral, followed by an interaction of obstructive CAD with pre-test likelihood of CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization increased from 3.8{\%} for non-high-risk CAD to 51.2{\%} high-risk CAD. In multivariable models, when compared with medical therapy, revascularization was associated with a survival advantage for patients with high-risk CAD [hazards ratio (HR) 0.38, 95{\%} confidence interval 0.18-0.83], with no difference in survival for patients with non-high-risk CAD (HR 3.24, 95{\%} CI 0.76-13.89) (P-value for interaction = 0.03).ConclusionIn an intermediate-term follow-up, coronary revascularization is associated with a survival benefit in patients with high-risk CAD by CCTA, with no apparent benefit of revascularization in patients with lesser forms of CAD.",
author = "Min, {James K.} and Berman, {Daniel S.} and Allison Dunning and Stephan Achenbach and Mouaz Al-Mallah and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Hyuk-Jae Chang and Victor Cheng and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Ricardo Cury and Augustin Delago and Gudrun Feuchtner and Martin Hadamitzky and Joerg Hausleiter and Philipp Kaufmann and Karlsberg, {Ronald P.} and Kim, {Yong Jin} and Jonathon Leipsic and Lin, {Fay Y.} and Erica Maffei and Fabian Plank and Gilbert Raff and Todd Villines and Labounty, {Troy M.} and Shaw, {Leslee J.}",
year = "2012",
month = "12",
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doi = "10.1093/eurheartj/ehs315",
language = "English",
volume = "33",
pages = "3088--3097",
journal = "European Heart Journal",
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Min, JK, Berman, DS, Dunning, A, Achenbach, S, Al-Mallah, M, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, H-J, Cheng, V, Chinnaiyan, K, Chow, BJW, Cury, R, Delago, A, Feuchtner, G, Hadamitzky, M, Hausleiter, J, Kaufmann, P, Karlsberg, RP, Kim, YJ, Leipsic, J, Lin, FY, Maffei, E, Plank, F, Raff, G, Villines, T, Labounty, TM & Shaw, LJ 2012, 'All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography: Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry)', European heart journal, vol. 33, no. 24, pp. 3088-3097. https://doi.org/10.1093/eurheartj/ehs315

All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography : Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry). / Min, James K.; Berman, Daniel S.; Dunning, Allison; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Cheng, Victor; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Cury, Ricardo; Delago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp; Karlsberg, Ronald P.; Kim, Yong Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Plank, Fabian; Raff, Gilbert; Villines, Todd; Labounty, Troy M.; Shaw, Leslee J.

In: European heart journal, Vol. 33, No. 24, 01.12.2012, p. 3088-3097.

Research output: Contribution to journalArticle

TY - JOUR

T1 - All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography

T2 - Results from CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter Registry)

AU - Min, James K.

AU - Berman, Daniel S.

AU - Dunning, Allison

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk-Jae

AU - Cheng, Victor

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo

AU - Delago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Joerg

AU - Kaufmann, Philipp

AU - Karlsberg, Ronald P.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Lin, Fay Y.

AU - Maffei, Erica

AU - Plank, Fabian

AU - Raff, Gilbert

AU - Villines, Todd

AU - Labounty, Troy M.

AU - Shaw, Leslee J.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Aims To date, the therapeutic benefit of revascularization vs. medical therapy for stable individuals undergoing invasive coronary angiography (ICA) based upon coronary computed tomographic angiography (CCTA) findings has not been examined.Methods and resultsWe examined 15 223 patients without known coronary artery disease (CAD) undergoing CCTA from eight sites and six countries who were followed for median 2.1 years (interquartile range 1.4-3.3 years) for an endpoint of all-cause mortality. Obstructive CAD by CCTA was defined as a ≥50% luminal diameter stenosis in a major coronary artery. Patients were categorized as having high-risk CAD vs. non-high-risk CAD, with the former including patients with at least obstructive two-vessel CAD with proximal left anterior descending artery involvement, three-vessel CAD, and left main CAD. Death occurred in 185 (1.2%) patients. Patients were categorized into two treatment groups: revascularization (n = 1103; 2.2% mortality) and medical therapy (n = 14 120, 1.1% mortality). To account for non-randomized referral to revascularization, we created a propensity score developed by logistic regression to identify variables that influenced the decision to refer to revascularization. Within this model (C index 0.92, χ2 = 1248, P < 0.0001), obstructive CAD was the most influential factor for referral, followed by an interaction of obstructive CAD with pre-test likelihood of CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization increased from 3.8% for non-high-risk CAD to 51.2% high-risk CAD. In multivariable models, when compared with medical therapy, revascularization was associated with a survival advantage for patients with high-risk CAD [hazards ratio (HR) 0.38, 95% confidence interval 0.18-0.83], with no difference in survival for patients with non-high-risk CAD (HR 3.24, 95% CI 0.76-13.89) (P-value for interaction = 0.03).ConclusionIn an intermediate-term follow-up, coronary revascularization is associated with a survival benefit in patients with high-risk CAD by CCTA, with no apparent benefit of revascularization in patients with lesser forms of CAD.

AB - Aims To date, the therapeutic benefit of revascularization vs. medical therapy for stable individuals undergoing invasive coronary angiography (ICA) based upon coronary computed tomographic angiography (CCTA) findings has not been examined.Methods and resultsWe examined 15 223 patients without known coronary artery disease (CAD) undergoing CCTA from eight sites and six countries who were followed for median 2.1 years (interquartile range 1.4-3.3 years) for an endpoint of all-cause mortality. Obstructive CAD by CCTA was defined as a ≥50% luminal diameter stenosis in a major coronary artery. Patients were categorized as having high-risk CAD vs. non-high-risk CAD, with the former including patients with at least obstructive two-vessel CAD with proximal left anterior descending artery involvement, three-vessel CAD, and left main CAD. Death occurred in 185 (1.2%) patients. Patients were categorized into two treatment groups: revascularization (n = 1103; 2.2% mortality) and medical therapy (n = 14 120, 1.1% mortality). To account for non-randomized referral to revascularization, we created a propensity score developed by logistic regression to identify variables that influenced the decision to refer to revascularization. Within this model (C index 0.92, χ2 = 1248, P < 0.0001), obstructive CAD was the most influential factor for referral, followed by an interaction of obstructive CAD with pre-test likelihood of CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization increased from 3.8% for non-high-risk CAD to 51.2% high-risk CAD. In multivariable models, when compared with medical therapy, revascularization was associated with a survival advantage for patients with high-risk CAD [hazards ratio (HR) 0.38, 95% confidence interval 0.18-0.83], with no difference in survival for patients with non-high-risk CAD (HR 3.24, 95% CI 0.76-13.89) (P-value for interaction = 0.03).ConclusionIn an intermediate-term follow-up, coronary revascularization is associated with a survival benefit in patients with high-risk CAD by CCTA, with no apparent benefit of revascularization in patients with lesser forms of CAD.

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