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Anatomic and functional imaging to predict long-term outcome and benefits of early revascularization in patients with suspected coronary artery disease: results from the EVINCI study.

Session CAD prognosis: is CT the new crystal ball?

Speaker Riccardo Liga

Event : ESC Congress 2017

  • Topic : imaging
  • Sub-topic : Computed Tomography
  • Session type : Advances in Science

Authors : D Neglia (Pisa,IT), R Liga (Pisa,IT), C Caselli (Pisa,IT), V Lorenzoni (Pisa,IT), G Turchetti (Pisa,IT), AJHA Scholte (Leiden,NL), R Sicari (Pisa,IT), J Zamorano (Madrid,ES), M Lombardi (San Donato Milanese,IT), O Gaemperli (Zurich,CH), PA Kaufmann (Zurich,CH), J Knuuti (Turku,FI), R Underwood (London,GB)

Authors:
D. Neglia1 , R. Liga2 , C. Caselli3 , V. Lorenzoni4 , G. Turchetti4 , A.J.H.A. Scholte5 , R. Sicari3 , J. Zamorano6 , M. Lombardi7 , O. Gaemperli8 , P.A. Kaufmann8 , J. Knuuti9 , R. Underwood10 , 1Fondazione Toscana G. Monasterio & CNR, Inst of Clinical Physiology, Pisa, Italy - Pisa - Italy , 2Azienda Ospedaliero-Universitaria Pisana - Pisa - Italy , 3CNR, Inst of Clinical Physiology, Pisa - Pisa - Italy , 4Scuola Superiore Sant'Anna - Pisa - Italy , 5Leiden University Medical Center - Leiden - Netherlands , 6University Hospital Ramon y Cajal de Madrid - Madrid - Spain , 7IRCCS, Policlinico San Donato - San Donato Milanese - Italy , 8University Hospital Zurich - Zurich - Switzerland , 9Turku University Hospital - Turku - Finland , 10Imperial College London - London - United Kingdom ,

On behalf: EVINCI Investigators

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1019-1020

Introduction: Whether integrated non-invasive anatomic-functional imaging may predict long-term outcome in patients with suspected coronary artery disease (CAD) is not fully known.

Purpose: We assessed the prognostic role of computed tomography coronary angiography (CTCA) and stress imaging in a contemporary population of patients with suspected CAD enrolled in the multicenter European EVINCI study.

Methods: Six-hundred and ninety-seven patients with suspected stable CAD were enrolled from 2009 to 2012. Among them, 430 underwent CTCA and stress cardiac imaging with SPECT or PET and ECHO or CMR. If one or more tests were abnormal (i.e. >50% stenosis in at least one major coronary vessel on CTCA or >10% of LV ischemia in at least one stress-test), they were submitted to invasive coronary angiography (ICA) and revascularized according to clinical judgment. Follow-up visits were planned at 3–6 months and every year after enrollment. Imaging studies were analyzed by dedicated core-labs. The primary end-point was composed of death, non fatal myocardial infarction, hospitalization for unstable angina or heart failure. The secondary end-point also included late revascularization (>90 days after enrollment).

Results: Mean age was 61±9 years, 62% were men and 25% had typical angina. The mean pretest likelihood of CAD was 49±19%. ICA was performed in 291 pts and showed hemodynamically significant CAD in a major coronary vessel (>70% stenosis and/or FFR <0.8) in 127 (44%). Early revascularization (<90 days) was performed in 90/291 pts (31%). Over a mean follow-up of 4.4 yrs, a primary end-point occurred in 40 patients (9.3%) and a secondary endpoint occurred in 58 (13.5%). Using Cox model, including imaging variables (i.e. presence/absence of abnormal CTCA and presence/absence of abnormal stress test), age, gender, risk factors, and treatment, a positive CTCA was an independent predictor of primary endpoint (HR 2.23, 95% CI 1.20–4.16, P=0.012) and of secondary end-point (HR 2.03, 95% CI, 1.18–3.51, P=0.011) (Figure 1) together with age >60 yrs (P=0.015) and male gender (P=0.007). Using combined CTCA and stress imaging data analysis, early revascularization significantly reduced primary end-point events in pts with “match” findings (i.e. coronary stenosis associated with >10% LV ischemia) but not in the others (10% vs 27% and 13% vs 8%, respectively, P=0.026 for interaction).

Conclusions: In a contemporary population of patients with suspected stable CAD a positive CTCA is an independent predictor of long-term outcome. Non invasive combined anatomic-functional imaging predicts the prognostic benefits of early revascularization.

Figure 1

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