Abstract 15846: Mortality Risk and Therapeutic Benefit of Coronary Revascularization versus Medical Therapy in 15,223 Patients Without Known Coronary Artery Disease Undergoing Coronary CT Angiography: Results from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)
Background. Coronary CT angiography (CCTA) can non-invasively assess coronary artery disease (CAD) severity. To date, the relative therapeutic benefit of revascularization vs. medical therapy based upon CCTA findings has not been examined.
Methods and Results. We examined 15,223 patients without known CAD undergoing CCTA from 8 sites and 6 countries followed for 2.2±1.3 yrs for all-cause mortality. Patients were categorized into 3 groups: no CAD, non-high-risk CAD, and high-risk CAD, with the latter inclusive of patients with ≥2-vessel obstructive CAD (≥70% stenosis) with proximal left anterior descending artery involvement, 3-vessel obstructive CAD, and left main obstructive CAD (≥50% stenosis). Death occurred in 185 (1.2%) patients, with adjusted mortality rates increasing for non-high-risk CAD (Hazards Ratio [HR] 1.82, 95% Confidence Interval [CI] 1.20-2.75, p=0.0048) and high-risk CAD (HR 3.11, 95%, CI 1.85-5.20, p<0.0001), as compared to no CAD. Rates of revascularization increased nonlinearly from 0.33% to 7.2% to 51.3% for no CAD, non-high-risk CAD and high-risk CAD (p<0.0001). In multivariable Cox models including a propensity score (C index 0.92, χ2=1241, P<0.0001) that included explanatory variables accounting for non-randomized referral to revascularization (n=14,118) vs. medical therapy (n=1,105), revascularization was associated with a survival advantage for patients with high-risk CAD [HR 0.51, 95% CI 0.26-0.997), no difference for patients with non-high-risk CAD (HR 0.75, 95%CI 0.36-1.54), and increased risk for mortality for patients with no CAD (HR 14.00, 95%CI 1.82-107.49) [p<0.0001] (Figure 1).
Conclusions: In an intermediate-term follow-up of this international registry, 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. These findings may help guide post-test treatment decisions following CCTA.
- © 2011 by American Heart Association, Inc.