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

Leslee J. Shaw, Jörg Hausleiter, Stephan Achenbach, Mouaz Al-Mallah, Daniel S. Berman, Matthew J. Budoff, Fillippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Yong Jin Kim, Victor Y. Cheng, Benjamin J.W. Chow, Ricardo C. Cury, Augustin J. Delago, Allison L. Dunning, Gudrun M. Feuchtner, Martin Hadamitzky, Ronald P. Karlsberg, Philipp A. Kaufmann, Jonathon LeipsicFay Y. Lin, Kavitha M. Chinnaiyan, Erica Maffei, Gilbert L. Raff, Todd C. Villines, Troy Labounty, Millie J. Gomez, James K. Min

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Pages (from-to)2103-2114
Number of pages12
JournalJournal of the American College of Cardiology
Volume60
Issue number20
DOIs
Publication statusPublished - 2012 Nov 13

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Coronary Angiography
Registries
Angiography
Coronary Artery Disease
Pathologic Constriction
Mortality
Coronary Stenosis
Computed Tomography Angiography
Proportional Hazards Models
Logistic Models
Calcium

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Shaw, Leslee J. ; Hausleiter, Jörg ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Berman, Daniel S. ; Budoff, Matthew J. ; Cademartiri, Fillippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Kim, Yong Jin ; Cheng, Victor Y. ; Chow, Benjamin J.W. ; Cury, Ricardo C. ; Delago, Augustin J. ; Dunning, Allison L. ; Feuchtner, Gudrun M. ; Hadamitzky, Martin ; Karlsberg, Ronald P. ; Kaufmann, Philipp A. ; Leipsic, Jonathon ; Lin, Fay Y. ; Chinnaiyan, Kavitha M. ; Maffei, Erica ; Raff, Gilbert L. ; Villines, Todd C. ; Labounty, Troy ; Gomez, Millie J. ; Min, James K. / 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. In: Journal of the American College of Cardiology. 2012 ; Vol. 60, No. 20. pp. 2103-2114.
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title = "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",
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.",
author = "Shaw, {Leslee J.} and J{\"o}rg Hausleiter and Stephan Achenbach and Mouaz Al-Mallah and Berman, {Daniel S.} and Budoff, {Matthew J.} and Fillippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kim, {Yong Jin} and Cheng, {Victor Y.} and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Delago, {Augustin J.} and Dunning, {Allison L.} and Feuchtner, {Gudrun M.} and Martin Hadamitzky and Karlsberg, {Ronald P.} and Kaufmann, {Philipp A.} and Jonathon Leipsic and Lin, {Fay Y.} and Chinnaiyan, {Kavitha M.} and Erica Maffei and Raff, {Gilbert L.} and Villines, {Todd C.} and Troy Labounty and Gomez, {Millie J.} and Min, {James K.}",
year = "2012",
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day = "13",
doi = "10.1016/j.jacc.2012.05.062",
language = "English",
volume = "60",
pages = "2103--2114",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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Shaw, LJ, Hausleiter, J, Achenbach, S, Al-Mallah, M, Berman, DS, Budoff, MJ, Cademartiri, F, Callister, TQ, Chang, HJ, Kim, YJ, Cheng, VY, Chow, BJW, Cury, RC, Delago, AJ, Dunning, AL, Feuchtner, GM, Hadamitzky, M, Karlsberg, RP, Kaufmann, PA, Leipsic, J, Lin, FY, Chinnaiyan, KM, Maffei, E, Raff, GL, Villines, TC, Labounty, T, Gomez, MJ & Min, JK 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, vol. 60, no. 20, pp. 2103-2114. https://doi.org/10.1016/j.jacc.2012.05.062

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

In: Journal of the American College of Cardiology, Vol. 60, No. 20, 13.11.2012, p. 2103-2114.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Coronary computed tomographic angiography as a gatekeeper to invasive diagnostic and surgical procedures

T2 - 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.

PY - 2012/11/13

Y1 - 2012/11/13

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.

AB - 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.

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