Abstract 18541: Anatomical and Functional Imaging to Predict Long-Term Outcome in Patients With Suspected Coronary Artery Disease: Results From the EVINCI Study
Introduction: Whether non-invasive anatomical and functional imaging may independently predict long-term outcome in patients with suspected coronary artery disease (CAD) is not fully known.
Aim: We compared the prognostic role of computed tomography coronary angiography (CTCA) and stress imaging in a contemporary population of patients with suspected CAD enrolled in the multicenter European EVINCI study.
Methods: In the EVINCI study, 697 patients with stable chest pain or equivalent symptoms were enrolled from 2009 to 2012. Among them, 475 underwent CTCA and stress cardiac imaging with SPECT or PET and ECHO or CMR. If one or more tests were abnormal, they underwent invasive coronary angiography (ICA) and were managed according to common clinical practice. Follow-up visits were planned at 3-6 months and every year after enrollment. The primary end-point was composed of cardiac death, non fatal myocardial infarction, hospitalization for unstable angina or heart failure. The secondary end-point also included late revascularization (>90 days after enrollment).
Results: Within 2015 the clinical follow-up was completed in 430 patients. Mean age was 61±9 years, 38% were women and 25% had typical angina. The mean pretest likelihood of CAD was 49±19% . At least one non-invasive imaging test was abnormal in 191 patients (44%) (CTCA in 76, stress imaging in 57, both in 58). ICA showed obstructive CAD (>50% stenosis in at least one major coronary vessel) in 26% of the patients and early revascularization (<90 days) was performed in 21%. Over a mean follow-up of 4.4 yrs, a primary end-point occurred in 29 patients (6.7 %) and a secondary end-point occurred in 47 (10.9%). Using Cox model, after correction for age, gender, risk factors, medical treatment and early revascularization, a positive CTCA (>50% stenosis in at least one major coronary vessel) was an independent predictor of primary (HR 3.97, 95% CI 1.68-9.39, P=0.002) and secondary (HR 3.13, 95% CI 1.59-6.19, P=0.001) end-points while a positive stress imaging was not.
Conclusions: In a contemporary multicenter European population of stable patients with intermediate pre-test probability of CAD and low prevalence of obstructive disease, a positive CTCA is an independent predictor of long-term outcome.
Author Disclosures: D. Neglia: None. R. Liga: None. C. Caselli: None. V. Lorenzoni: None. A.J. Scholte: None. R. Sicari: None. J. Zamorano: None. M. Lombardi: None. P.A. Kaufmann: None. J. Knuuti: None. R. Underwood: None.
- © 2016 by American Heart Association, Inc.