Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study.
clinical outcome
computed tomography coronary angiography
coronary anatomical imaging
coronary functional imaging
coronary revascularization
prognosis
stable coronary artery disease
Journal
European heart journal. Cardiovascular Imaging
ISSN: 2047-2412
Titre abrégé: Eur Heart J Cardiovasc Imaging
Pays: England
ID NLM: 101573788
Informations de publication
Date de publication:
20 10 2020
20 10 2020
Historique:
received:
15
05
2019
revised:
06
09
2019
accepted:
25
10
2019
pubmed:
9
11
2019
medline:
29
6
2021
entrez:
9
11
2019
Statut:
ppublish
Résumé
To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD). 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). 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.
Identifiants
pubmed: 31701136
pii: 5614586
doi: 10.1093/ehjci/jez248
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1273-1282Investigateurs
D Neglia
(D)
D Rovai
(D)
C Caselli
(C)
M Pietila
(M)
A Teresinska
(A)
S Aguadé-Bruix
(S)
M N Pizzi
(MN)
G Todiere
(G)
A Gimelli
(A)
S Schroeder
(S)
T Drosch
(T)
R Poddighe
(R)
G Casolo
(G)
C Anagnostopoulos
(C)
F Pugliese
(F)
F Rouzet
(F)
D Le Guludec
(D)
F Cappelli
(F)
S Valente
(S)
G F Gensini
(GF)
C Zawaideh
(C)
S Capitanio
(S)
G Sambuceti
(G)
F Marsico
(F)
P Perrone Filardi
(P)
C Fernández-Golfín
(C)
L M Rincón
(LM)
F P Graner
(FP)
M A de Graaf
(MA)
M Fiechter
(M)
J Stehli
(J)
O Gaemperli
(O)
E Reyes
(E)
S Nkomo
(S)
M Mäki
(M)
V Lorenzoni
(V)
G Turchetti
(G)
C Carpeggiani
(C)
M Marinelli
(M)
S Puzzuoli
(S)
M Mangione
(M)
P Marcheschi
(P)
F Mariani
(F)
D Giannessi
(D)
S Nekolla
(S)
M Lombardi
(M)
R Sicari
(R)
A J Scholte
(AJ)
J L Zamorano
(JL)
P A Kaufmann
(PA)
S R Underwood
(SR)
J Knuuti
(J)
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.