CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial

Mancini, G.B. John; Leipsic, Jonathan; Budoff, Matthew J.; Hague, Cameron; Min, James K.; Stevens, Susanna R.; Reynolds, Harmony R.; O’Brien, Sean M.; Shaw, Leslee J.; Manjunath, Cholenahally Nanjappa; Mavromatis, Kreton; Demkow, Marcin; López‐Sendón, José; Chernavskiy, Alexander M.; Gosselin, Gilbert; Schuchlenz, Herwig; Devlin, Gerard; Chauhan, Anoop; Bangalore, Sripal; Hochman, Judith S.; Maron, David J.

doi:10.1016/j.jcmg.2020.11.012

Cited by 44 publications

(23 citation statements)

References 26 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As outlined in a recent publication, the discordance is likely due to ostial LAD or ostial left circumflex CAD that might have led to discordance with invasive angiography, generally due to the limited views on invasive angiography. 7 Despite this, we did not observe any meaningful heterogeneity of treatment effect. Similar to the overall findings in the ISCHEMIA trial, the invasive strategy increased procedural MI, reduced nonprocedural MI, and showed no significant difference for other clinical outcomes.…”

Section: Discussionmentioning

confidence: 54%

Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA Trial

Bangalore

Spertus

Stevens

et al. 2022

Circ: Cardiovascular Interventions

Self Cite

View full text Add to dashboard Cite

Background: Patients with significant (≥50%) left main disease (LMD) have a high risk of cardiovascular events, and guidelines recommend revascularization to improve survival. However, the impact of intermediate LMD (stenosis, 25%–49%) on outcomes is unclear. Methods: Randomized ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) participants who underwent coronary computed tomography angiography at baseline were categorized into those with (25%–49%) and without (<25%) intermediate LMD. The primary outcome was a composite of cardiovascular mortality, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. The primary quality of life outcome was the Seattle Angina Questionnaire summary score. Results: Among the 3699 participants who satisfied the inclusion criteria, 962 (26%) had intermediate LMD. Among invasive strategy participants with intermediate LMD on coronary computed tomography angiography, 49 (7.0%) had significant (≥50% stenosis) left main stenosis on invasive angiography. Patients with intermediate LMD had a higher risk of cardiovascular events in the unadjusted but not in the fully adjusted model compared with those without intermediate LMD. An invasive strategy increased procedural MI and decreased nonprocedural MI with no significant difference for other outcomes including the primary end point. There was no meaningful heterogeneity of treatment effect based on intermediate LMD status except for nonprocedural MI for which there was a greater absolute reduction with invasive management in the intermediate LMD group (−6.4% versus −2.0%; P interaction =0.049). The invasive strategy improved angina-related quality of life and the benefit was durable throughout follow-up without significant heterogeneity based on intermediate LMD status. Conclusions: In the ISCHEMIA trial, there was no meaningful heterogeneity of treatment benefit from an invasive strategy regardless of intermediate LMD status except for a greater absolute risk reduction in nonprocedural MI with invasive management in those with intermediate LMD. An invasive strategy increased procedural MI, reduced nonprocedural MI, and improved angina-related quality of life. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522.

show abstract

Section: Discussionmentioning

confidence: 54%

Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA Trial

Bangalore

Spertus

Stevens

et al. 2022

Circ: Cardiovascular Interventions

Self Cite

View full text Add to dashboard Cite

show abstract

“…As a significant aside, the ISCHEMIA investigators determined during post-hoc analysis that 20% of the patients enrolled were found to have no flow limiting lesions on cardiac CT 18 ; all the studies performed for ISCHEMIA patients were rigorously reviewed in core labora-tories. In light of the well-established negative predictive value of cardiac CT, 19 this finding further emphasizes the value of cardiac CT over functional imaging modalities.…”

Section: Cardiac Ctmentioning

confidence: 75%

Three Technologies That Will Guide Revascularization of Chronic Coronary Syndrome Patients into the 21st Century: A Review

Winkler

Patel

et al. 2021

Int J Angiol

View full text Add to dashboard Cite

Although medical therapy is the preferred first-line treatment for patients with chronic coronary syndrome (CCS), revascularization remains an important consideration. We present a review that identifies the three diagnostic technologies most important to guiding the decision to revascularize patients with CCS: (1) cardiac computed tomography, (2) intracoronary imaging, and (3) lesion-specific physiological guidance.

show abstract

“…CCTA clearly provides high accuracy for detecting obstructive CAD, and the high NPV determines CCTA as an effective non-invasive imaging procedure to exclude significant CAD in all risk groups, including stable symptomatic patients and those with acute coronary syndrome (17)(18)(19)(20). A previous study showed that up to 80% of ICAs can be avoided for patients with a low prevalence of CAD, since CCTA can effectively determine the need for ICA (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Performance of Coronary Computed Tomographic Angiography Compared With Invasive Coronary Angiography in Symptomatic Patients: Long–term Prognostic Implications

Baykız¹,

Gövdeli²,

Demirtakan³

et al. 2022

jmed

View full text Add to dashboard Cite

Objective: We aimed to investigate the diagnostic accuracy of 64-multidetector coronary computed tomographic angiography (CCTA) for stable symptomatic patients and evaluate the relationship between severity of coronary artery disease (CAD), cardiovascular risk scores, and coronary artery calcium (CAC) scores. We also assessed the possible predictors of all-cause mortality at a median of 10 years of follow-up.

show abstract

CT Angiography Followed by Invasive Angiography in Patients With Moderate or Severe Ischemia-Insights From the ISCHEMIA Trial

Cited by 44 publications

References 26 publications

Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA Trial

Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA Trial

Three Technologies That Will Guide Revascularization of Chronic Coronary Syndrome Patients into the 21st Century: A Review

The Diagnostic Performance of Coronary Computed Tomographic Angiography Compared With Invasive Coronary Angiography in Symptomatic Patients: Long–term Prognostic Implications

Contact Info

Product

Resources

About