Author + information
- Mahn Won Park,
- Ji Hyun Lee,
- Briain O. Hartaigh,
- Asim Rizvi,
- Donghee Han,
- Hadi Mirhedayati Roudsari,
- Subhi Al'Aref,
- Khalil Anchouche,
- Ashley Beecy,
- Heidi Gransar,
- Yao Lu,
- Jessica Pena,
- James Min,
- Fay Lin,
- on behalf of the CONFIRM Investigators
Background: Diagnostic accuracy of coronary computed tomographic angiography (CCTA) for coronary artery stent evaluation and in-stent restenosis (ISR) is inferior to that of native coronary disease. To date, no data have evaluated the prognostic value of obstructive (OBS) and non-obstructive (NOBS) stents determined by CCTA, particularly based on stent position.
Methods: From the prospective CONFIRM registry of 35,281 individuals undergoing CCTA, 390 (OBS: n=87, NOBS: n=303) patients with single stent evaluated by CCTA and with major adverse cardiovascular events (MACE) follow up information were included. Those with multiple stents were omitted. OBS was defined as having a stented coronary artery segment with ISR ≥50%. Patients were followed for MACE, which included all-cause death, non-fatal myocardial infarction, and late target vessel revascularization (≥90 days). We evaluated the risk of MACE with Cox proportional hazards regression analysis for OBS compared with NOBS. We examined the risk by subsets of proximal or mid segment (n=346) as well as distal segment (n=44) stents.
Results: During a median follow up of 4.9 (IQR 2.6-5.3) years, a total of 107 (27%) MACE occurred (15 deaths, 42 non-fatal myocardial infarction, and 74 late revascularization). Although the cumulative incidence (33% vs. 25%, P =0.16) and risk (HR 1.41, 95% CI: 0.91-2.18, P=0.25) of MACE were somewhat higher among OBS versus NOBS patients, these differences were not significant. Likewise, the risk of MACE was nonsignificantly higher for OBS in the subsets with proximal or mid segment (HR 1.23, 95% CI: 0.77-1.96, P=0.12) and distal segment (HR 3.53, 95% CI: 0.92-13.54, P=0.34) stents.
Conclusions: In the largest cohort of CCTA-evaluated stents to date, risk of MACE was not different between OBS and NOBS, irrespective of stent position. This contrasts with the well-established prognostic value of CCTA for native coronary artery disease.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: Prognostic Implications of CT Angiography
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1247-233
- 2017 American College of Cardiology Foundation