Abstract 13475: Rates and Predictors of Invasive Coronary Angiography and Coronary Revascularization Following Coronary Computed Tomographic Angiography: Results From 15,223 Patients within the CONFIRM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An InteRnational Multicenter Registry)
Background. Coronary CT angiography (CCTA) is a non-invasive method that allows for direct visualization of the extent and severity of anatomic coronary artery disease (CAD). Patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) following CCTA have not been defined.
Methods. We examined 15,223 patients with suspected CAD undergoing CCTA from 8 sites in 6 countries followed for 2.2+1.3 yrs. CAD was judged as <50% stenosis and obstructive (>50%) for 1-, 2- or 3-vessel disease (VD) or left main stenosis >50% (LM). We determined rates of downstream ICA and REV, and further examined logistic regression predictors of ICA.
Results. At 2.4±1.2 years, 2,218 ICAs and 1,211 REV occurred; 80% occured ≤3 months post-CCTA. CAD extent and severity was: 79% with <50% stenosis; 12% 1VD; 6% 2VD; 3% 3VD/LM. Obstructive CAD extent was associated with higher rates of ICA for 1VD (44%), 2VD (53%) and 3VD/LM (69%). In multivariable models, clinical and CCTA predictors of early ICA included current smoker (Odds Ratio [OR] 1.54, 95% confidence interval [CI] 1.00-2.38, p=0.05), 2- or 3-VD (OR 3.75, 95% CI 2.07-6.80, p<0.0001), and obstructive CAD in the left anterior descending [LAD] (OR 1.75, 95% 1.22-2.51, p=0.002) and LM (OR 1.63, 95% CI 1.14-2.31) arteries. Of those undergoing ICA during follow-up, REV occurred in 53%, 66%, and 82% of patients with CCTA-defined 1, 2, and 3VD/LM (p<0.0001). Within 3 months of CCTA, only 3% of patients with <50% stenosis underwent ICA. By 2 years of follow-up post-CCTA, 4.9% of patients with <50% stenosis underwent ICA. In multivariable models, clinical and CCTA predictors of ICA in patients with <50% stenosis included chest pain as an indication for CCTA (OR 1.49, 95% CI 1.00-2.21, p=0.048) and LM plaque OR 1.26, 95% CI 1.04-1.53, p=0.018).
Conclusions: In an intermediate-term follow-up of patients undergoing CCTA, ICA and REV rates are low in patients with no or non-obstructive CAD, with only approximately half of patients with obstructive CAD undergoing ICA. Obstructive CAD in increasing numbers of coronary arteries and presence of plaque in the LAD or LM artery are associated with increased rates of ICA. These data support that CCTA may be effectively used as a gatekeeper to ICA.
- © 2011 by American Heart Association, Inc.