Coronary Computed Tomographic Angiography as a Gatekeeper to Invasive Diagnostic and Surgical Procedures

Objectives This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA). Background CCTA is a noninvasive test that permits direct visualization of the extent and severity of coronary artery d...

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Veröffentlicht in:	Journal of the American College of Cardiology 2012-11, Vol.60 (20), p.2103-2114
Hauptverfasser:	Shaw, Leslee J., PhD, Hausleiter, Jörg, MD, Achenbach, Stephan, MD, Al-Mallah, Mouaz, MD, Berman, Daniel S., MD, Budoff, Matthew J., MD, Cademartiri, Fillippo, MD, Callister, Tracy Q., MD, Chang, Hyuk-Jae, MD, PhD, Kim, Yong-Jin, MD, Cheng, Victor Y., MD, Chow, Benjamin J.W., MD, Cury, Ricardo C., MD, Delago, Augustin J., MD, Dunning, Allison L., MS, Feuchtner, Gudrun M., MD, PD, Hadamitzky, Martin, MD, Karlsberg, Ronald P., MD, Kaufmann, Philipp A., MD, Leipsic, Jonathon, MD, Lin, Fay Y., MD, MPH, Chinnaiyan, Kavitha M., MD, Maffei, Erica, MD, Raff, Gilbert L., MD, Villines, Todd C., MD, LaBounty, Troy, MD, Gomez, Millie J., MD, Min, James K., MD
Format:	Artikel
Sprache:	eng
Schlagworte:	Accuracy Acute coronary syndromes Age Angina pectoris Cardiology Cardiovascular Cardiovascular disease Classification Clinical outcomes Confidence intervals coronary computed tomography Coronary vessels Diabetes Family medical history health services research Heart attacks Hypertension Internal Medicine Intubation Logistics Medical imaging Medicare Pain prognosis resource utilization Statistical methods
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Zusammenfassung:	Objectives This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA). Background CCTA is 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. Methods We examined 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. Results During 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
ISSN:	0735-1097 1558-3597
DOI:	10.1016/j.jacc.2012.05.062