Cited 96 times in
Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial
DC Field | Value | Language |
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dc.contributor.author | 장혁재 | - |
dc.contributor.author | 정남식 | - |
dc.contributor.author | 한동희 | - |
dc.contributor.author | 성지민 | - |
dc.date.accessioned | 2019-09-20T07:48:22Z | - |
dc.date.available | 2019-09-20T07:48:22Z | - |
dc.date.issued | 2019 | - |
dc.identifier.issn | 1936-878X | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/171062 | - |
dc.description.abstract | OBJECTIVES: This study compared the safety and diagnostic yield of a selective referral strategy using coronary computed tomographic angiography (CCTA) compared with a direct referral strategy using invasive coronary angiography (ICA) as the index procedure. BACKGROUND: Among patients presenting with signs and symptoms suggestive of coronary artery disease (CAD), a sizeable proportion who are referred to ICA do not have a significant, obstructive stenosis. METHODS: In a multinational, randomized clinical trial of patients referred to ICA for nonemergent indications, a selective referral strategy was compared with a direct referral strategy. The primary endpoint was noninferiority with a multiplicative margin of 1.33 of composite major adverse cardiovascular events (blindly adjudicated death, myocardial infarction, unstable angina, stroke, urgent and/or emergent coronary revascularization or cardiac hospitalization) at a median follow-up of 1-year. RESULTS: At 22 sites, 823 subjects were randomized to a selective referral and 808 to a direct referral strategy. At 1 year, selective referral met the noninferiority margin of 1.33 (p = 0.026) with a similar event rate between the randomized arms of the trial (4.6% vs. 4.6%; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.47). Following CCTA, only 23% of the selective referral arm went on to ICA, which was a rate lower than that of the direct referral strategy. Coronary revascularization occurred less often in the selective referral group compared with the direct referral to ICA (13% vs. 18%; p < 0.001). Rates of normal ICA were 24.6% in the selective referral arm compared with 61.1% in the direct referral arm of the trial (p < 0.001). CONCLUSIONS: In stable patients with suspected CAD who are eligible for ICA, the comparable 1-year major adverse cardiovascular events rates following a selective referral and direct referral strategy suggests that both diagnostic approaches are similarly effective. In the selective referral strategy, the reduced use of ICA was associated with a greater diagnostic yield, which supported the usefulness of CCTA as an efficient and accurate method to guide decisions of ICA performance. (Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization [CONSERVE]; NCT01810198). | - |
dc.description.statementOfResponsibility | restriction | - |
dc.language | English | - |
dc.publisher | Elsevier | - |
dc.relation.isPartOf | JACC. Cardiovascular Imaging | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.title | Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Internal Medicine (내과학교실) | - |
dc.contributor.googleauthor | Hyuk-Jae Chang | - |
dc.contributor.googleauthor | Fay Y. Lin | - |
dc.contributor.googleauthor | Dan Gebow | - |
dc.contributor.googleauthor | Hae Young An | - |
dc.contributor.googleauthor | Daniele Andreini | - |
dc.contributor.googleauthor | Ravi Bathina | - |
dc.contributor.googleauthor | Andrea Baggiano | - |
dc.contributor.googleauthor | Virginia Beltrama | - |
dc.contributor.googleauthor | Rodrigo Cerci | - |
dc.contributor.googleauthor | Eui-Young Choi | - |
dc.contributor.googleauthor | Jung-Hyun Choi | - |
dc.contributor.googleauthor | So-Yeon Choi | - |
dc.contributor.googleauthor | Namsik Chung | - |
dc.contributor.googleauthor | Jason Cole | - |
dc.contributor.googleauthor | Joon-Hyung Doh | - |
dc.contributor.googleauthor | Sang-Jin Ha | - |
dc.contributor.googleauthor | Ae-Young Her | - |
dc.contributor.googleauthor | Cezary Kepka | - |
dc.contributor.googleauthor | Jang-Young Kim | - |
dc.contributor.googleauthor | Jin-Won Kim | - |
dc.contributor.googleauthor | Sang-Wook Kim | - |
dc.contributor.googleauthor | Woong Kim | - |
dc.contributor.googleauthor | Gianluca Pontone | - |
dc.contributor.googleauthor | Uma Valeti | - |
dc.contributor.googleauthor | Todd C. Villines | - |
dc.contributor.googleauthor | Yao Lu | - |
dc.contributor.googleauthor | Amit Kumar | - |
dc.contributor.googleauthor | Iksung Cho | - |
dc.contributor.googleauthor | Ibrahim Danad | - |
dc.contributor.googleauthor | Donghee Han | - |
dc.contributor.googleauthor | Ran Heo | - |
dc.contributor.googleauthor | Sang-Eun Lee | - |
dc.contributor.googleauthor | Ji Hyun Lee | - |
dc.contributor.googleauthor | Hyung-Bok Park | - |
dc.contributor.googleauthor | Ji-min Sung | - |
dc.contributor.googleauthor | David Leflang | - |
dc.contributor.googleauthor | Joseph Zullo | - |
dc.contributor.googleauthor | Leslee J. Shaw | - |
dc.contributor.googleauthor | James K. Min | - |
dc.identifier.doi | 10.1016/j.jcmg.2018.09.018 | - |
dc.contributor.localId | A03490 | - |
dc.contributor.localId | A03585 | - |
dc.contributor.localId | A04811 | - |
dc.relation.journalcode | J01192 | - |
dc.identifier.eissn | 1876-7591 | - |
dc.identifier.pmid | 30553687 | - |
dc.identifier.url | https://www.sciencedirect.com/science/article/pii/S1936878X18309215 | - |
dc.subject.keyword | coronary computed tomographic angiography | - |
dc.subject.keyword | invasive coronary angiography | - |
dc.subject.keyword | major adverse cardiac events | - |
dc.subject.keyword | stable ischemic heart disease | - |
dc.contributor.alternativeName | Chang, Hyuck Jae | - |
dc.contributor.affiliatedAuthor | 장혁재 | - |
dc.contributor.affiliatedAuthor | 정남식 | - |
dc.contributor.affiliatedAuthor | 한동희 | - |
dc.citation.volume | 12 | - |
dc.citation.number | 7 | - |
dc.citation.startPage | 1303 | - |
dc.citation.endPage | 1312 | - |
dc.identifier.bibliographicCitation | JACC. Cardiovascular Imaging, Vol.12(7) : 1303-1312, 2019 | - |
dc.identifier.rimsid | 64125 | - |
dc.type.rims | ART | - |
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