Author/Authors :
Shaw، نويسنده , , Leslee J. and Hausleiter، نويسنده , , Jِrg and Achenbach، نويسنده , , Stephan and Al-Mallah، نويسنده , , Mouaz and Berman، نويسنده , , Daniel S. and Budoff، نويسنده , , Matthew J. and Cademartiri، نويسنده , , Fillippo and Callister، نويسنده , , Tracy Q. and Chang، نويسنده , , Hyuk-Jae and Kim، نويسنده , , Yongjin and Cheng، نويسنده , , Victor Y. and Chow، نويسنده , , Benjamin J.W. and Cury، نويسنده , , Ricardo C. and Delago، نويسنده , , Augustin J. and Dunning، نويسنده , , Allison L. and Feuchtner، نويسنده , , Gudrun M. and Hadamitzky، نويسنده , , Martin and Karlsberg، نويسنده , , Ronald P. and Kaufmann، نويسنده , , Philipp A. and Leipsic، نويسنده , , Jonathon and Lin، نويسنده , , Fay Y. and Chinnaiyan، نويسنده , , Kavitha M. and Maffei، نويسنده , , Erica and Raff، نويسنده , , Gilbert L. and Villines، نويسنده , , Todd C. and LaBounty، نويسنده , , Troy and Gomez، نويسنده , , Millie J. and Min، نويسنده , , James K.، نويسنده ,
Abstract :
Objectives
tudy sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA).
ound
s a noninvasive test that permits direct visualization of the extent and severity of coronary artery disease (CAD). Post-CCTA patterns of follow-up ICA and REV are incompletely defined.
s
mined 15,207 intermediate likelihood patients from 8 sites in 6 countries; these patients were without known CAD, underwent CCTA, and were followed up for 2.3 ± 1.2 years for all-cause mortality. Coronary artery stenosis was judged as obstructive when ≥50% stenosis was present. A multivariable logistic regression was used to estimate ICA use. A Cox proportional hazards model was used to estimate all-cause mortality.
s
follow-up, ICA rates for patients with no CAD to mild CAD according to CCTA were low (2.5% and 8.3%), with similarly low rates of REV (0.3% and 2.5%). Most ICA procedures (79%) occurred ≤3 months of CCTA. Obstructive CAD was associated with higher rates of ICA and REV for 1-vessel (44.3% and 28.0%), 2-vessel (53.3% and 43.6%), and 3-vessel (69.4% and 66.8%) CAD, respectively. For patients with <50% stenosis, early ICA rates were elevated; over the entirety of follow-up, predictors of ICA were mild left main, mild proximal CAD, respectively, or higher coronary calcium scores. In patients with <50% stenosis, the relative hazard for death was 2.2 (p = 0.011) for ICA versus no ICA. Conversely, for patients with CAD, the relative hazard for death was 0.61 for ICA versus no ICA (p = 0.047).
sions
findings support the concept that CCTA may be used effectively as a gatekeeper to ICA.
