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

LJ Shaw, J Hausleiter, S Achenbach, M Al-Mallah, DS Berman, MJ Budoff, F. Cademartiri, TQ Callister, HJ Chang, YJ Kim, VY Cheng, BJW Chow, RC Cury, AJ Delago, AL Dunning, GM Feuchtner, M Hadamitzky, RP Karlsberg, PA Kaufmann, J LeipsicFY Lin, KM Chinnaiyan, E Maffei, GL Raff, TC Villines, T Labounty, MJ Gomez, JK Min

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Abstract

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 <50% stenosis, early ICA rates were elevated; over the entirety of follow-up, predicto Conclusions These findings support the concept that CCTA may be used effectively as a gatekeeper to ICA. (J Am Coll Cardiol 2012;60:2103-14) (C) 2012 by the American College of Cardiology Foundation
Original languageUndefined/Unknown
Pages (from-to)2103-2114
Number of pages12
JournalJournal of the American College of Cardiology
Volume60
Issue number20
DOIs
Publication statusPublished - 2012

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