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

Authors
 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 Feuchtner  ;  Ronen Rubinshtein  ;  Gianluca Pontone  ;  Daniele Andreini  ;  Hugo Marques  ;  Hyuk-Jae Chang  ;  Benjamin J.W. Chow  ;  Ricardo C. Cury  ;  Allison Dunning  ;  Leslee Shaw  ;  James K. Min 
Citation
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, Vol.18(8) : 841-848, 2017 
Journal Title
 EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING 
ISSN
 2047-2404 
Issue Date
2017
Keywords
CAD ; coronary-computed tomographic angiography ; revascularization
Abstract
Aims: To identify the effect of early revascularization on 5-year survival in patients with CAD diagnosed by coronary-computed 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.
Files in This Item:
T201703524.pdf Download
DOI
10.1093/ehjci/jew287
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160875
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