Danilo Neglia1,2,3, Riccardo Liga4, Chiara Caselli2, Clara Carpeggiani2, Valentina Lorenzoni3, Rosa Sicari2, Massimo Lombardi5, Oliver Gaemperli6, Philipp A Kaufmann7, Arthur J H A Scholte8, S Richard Underwood9, Juhani Knuuti10. 1. Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy. 2. CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy. 3. Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy. 4. Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy. 5. Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milano, Italy. 6. Cardiology, HeartClinic Hirslanden, Witellikerstrasse 40, 8032, Zürich, Switzerland. 7. Cardiac Imaging, Nuclear Medicine Department, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. 8. Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300 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, 20521 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Andrea Baggiano; Gianpiero Italiano; Marco Guglielmo; Laura Fusini; Andrea Igoren Guaricci; Riccardo Maragna; Carlo Maria Giacari; Saima Mushtaq; Edoardo Conte; Andrea Daniele Annoni; Alberto Formenti; Maria Elisabetta Mancini; Daniele Andreini; Mark Rabbat; Mauro Pepi; Gianluca Pontone Journal: J Clin Med Date: 2022-01-18 Impact factor: 4.241
Authors: Roel S Driessen; Michiel J Bom; Pepijn A van Diemen; Stefan P Schumacher; Remi M Leonora; Henk Everaars; Albert C van Rossum; Pieter G Raijmakers; Peter M van de Ven; Cornelis C van Kuijk; Adriaan A Lammertsma; Juhani Knuuti; Amir Ahmadi; James K Min; Jonathon A Leipsic; Jagat Narula; Ibrahim Danad; Paul Knaapen Journal: Eur Heart J Cardiovasc Imaging Date: 2020-10-01 Impact factor: 6.875