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Eur Heart J Cardiovasc Imaging. 2019 Nov 8. pii: jez248. doi: 10.1093/ehjci/jez248. [Epub ahead of print]

Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study.

Author information

1
Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, Pisa, Italy.
2
CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, Pisa, Italy.
3
Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, Pisa, Italy.
4
Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, Pisa, Italy.
5
Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato Milanese, Milano, Italy.
6
Cardiology, HeartClinic Hirslanden, Witellikerstrasse 40, Zürich, Switzerland.
7
Cardiac Imaging, Nuclear Medicine Department, University Hospital Zürich, Rämistrasse 100, Zürich, Switzerland.
8
Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, RC, Leiden, The Netherlands.
9
Department of Non-Invasive Cardiac Imaging, Royal Brompton Hospital and Harefield Hospital, 250 King's Rd, Chelsea, London SW3 5UE, UK.
10
PET Center, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland.

Abstract

AIMS:

To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD).

METHODS AND RESULTS:

From March 2009 to June 2012, 430 patients with suspected CAD (61 ± 9 years, 62% men) underwent coronary anatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followed by invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CAD was documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratory analysis showed that 134 patients had obstructive CAD by CTCA (>50% stenosis in major coronary vessels) and 79 significant ischaemia by functional imaging [>10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4 years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstable angina or heart failure) or AEs plus late revascularization (LR) occurred in 40 (9.3%) and 58 (13.5%) patients, respectively. Obstructive CAD at CTCA was the only independent imaging predictor of AEs [hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.10-9.30; P = 0.033] and AEs plus LR (HR 4.3, 95% CI 1.56-11.81; P = 0.005). Patients with CAD in whom early revascularization was performed in the presence of ischaemia and deferred in its absence had fewer AEs, similar to patients without CAD (HR 2.0, 95% CI 0.71-5.51; P = 0.195).

CONCLUSION:

Obstructive CAD imaged by CTCA is an independent predictor of clinical outcome. Early management of CAD targeted to the combined anatomical and functional disease phenotype improves clinical outcome.

KEYWORDS:

clinical outcome; computed tomography coronary angiography; coronary anatomical imaging; coronary functional imaging; coronary revascularization; prognosis; stable coronary artery disease

PMID:
31701136
DOI:
10.1093/ehjci/jez248

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