PMID- 31701136 OWN - NLM STAT- MEDLINE DCOM- 20210625 LR - 20210625 IS - 2047-2412 (Electronic) IS - 2047-2404 (Linking) VI - 21 IP - 11 DP - 2020 Oct 20 TI - Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study. PG - 1273-1282 LID - 10.1093/ehjci/jez248 [doi] AB - 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. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. FAU - Neglia, Danilo AU - Neglia D AD - Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, 56124 Pisa, Italy. AD - CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy. AD - Sant'Anna School of Advanced Studies, Piazza Martiri della Liberta, 33, 56127 Pisa, Italy. FAU - Liga, Riccardo AU - Liga R AD - Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Via Roma, 67, 56126 Pisa, Italy. FAU - Caselli, Chiara AU - Caselli C AD - CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy. FAU - Carpeggiani, Clara AU - Carpeggiani C AD - CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy. FAU - Lorenzoni, Valentina AU - Lorenzoni V AD - Sant'Anna School of Advanced Studies, Piazza Martiri della Liberta, 33, 56127 Pisa, Italy. FAU - Sicari, Rosa AU - Sicari R AD - CNR, Institute of Clinical Physiology, Via G. Moruzzi 1, 56124 Pisa, Italy. FAU - Lombardi, Massimo AU - Lombardi M AD - Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milano, Italy. FAU - Gaemperli, Oliver AU - Gaemperli O AD - Cardiology, HeartClinic Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland. FAU - Kaufmann, Philipp A AU - Kaufmann PA AD - Cardiac Imaging, Nuclear Medicine Department, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland. FAU - Scholte, Arthur J H A AU - Scholte AJHA AD - Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. FAU - Underwood, S Richard AU - Underwood SR AD - Department of Non-Invasive Cardiac Imaging, Royal Brompton Hospital and Harefield Hospital, 250 King's Rd, Chelsea, London SW3 5UE, UK. FAU - Knuuti, Juhani AU - Knuuti J AD - PET Center, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland. CN - EVINCI Study Investigators LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Eur Heart J Cardiovasc Imaging JT - European heart journal. Cardiovascular Imaging JID - 101573788 SB - IM MH - Computed Tomography Angiography MH - Coronary Angiography MH - *Coronary Artery Disease/diagnostic imaging MH - Female MH - Humans MH - Male MH - Outcome Assessment, Health Care MH - Predictive Value of Tests MH - Prognosis OTO - NOTNLM OT - clinical outcome OT - computed tomography coronary angiography OT - coronary anatomical imaging OT - coronary functional imaging OT - coronary revascularization OT - prognosis OT - stable coronary artery disease FIR - Neglia, D IR - Neglia D FIR - Rovai, D IR - Rovai D FIR - Caselli, C IR - Caselli C FIR - Pietila, M IR - Pietila M FIR - Teresinska, A IR - Teresinska A FIR - Aguade-Bruix, S IR - Aguade-Bruix S FIR - Pizzi, M N IR - Pizzi MN FIR - Todiere, G IR - Todiere G FIR - Gimelli, A IR - Gimelli A FIR - Schroeder, S IR - Schroeder S FIR - Drosch, T IR - Drosch T FIR - Poddighe, R IR - Poddighe R FIR - Casolo, G IR - Casolo G FIR - Anagnostopoulos, C IR - Anagnostopoulos C FIR - Pugliese, F IR - Pugliese F FIR - Rouzet, F IR - Rouzet F FIR - Le Guludec, D IR - Le Guludec D FIR - Cappelli, F IR - Cappelli F FIR - Valente, S IR - Valente S FIR - Gensini, G F IR - Gensini GF FIR - Zawaideh, C IR - Zawaideh C FIR - Capitanio, S IR - Capitanio S FIR - Sambuceti, G IR - Sambuceti G FIR - Marsico, F IR - Marsico F FIR - Perrone Filardi, P IR - Perrone Filardi P FIR - Fernandez-Golfin, C IR - Fernandez-Golfin C FIR - Rincon, L M IR - Rincon LM FIR - Graner, F P IR - Graner FP FIR - de Graaf, M A IR - de Graaf MA FIR - Fiechter, M IR - Fiechter M FIR - Stehli, J IR - Stehli J FIR - Gaemperli, O IR - Gaemperli O FIR - Reyes, E IR - Reyes E FIR - Nkomo, S IR - Nkomo S FIR - Maki, M IR - Maki M FIR - Lorenzoni, V IR - Lorenzoni V FIR - Turchetti, G IR - Turchetti G FIR - Carpeggiani, C IR - Carpeggiani C FIR - Marinelli, M IR - Marinelli M FIR - Puzzuoli, S IR - Puzzuoli S FIR - Mangione, M IR - Mangione M FIR - Marcheschi, P IR - Marcheschi P FIR - Mariani, F IR - Mariani F FIR - Giannessi, D IR - Giannessi D FIR - Nekolla, S IR - Nekolla S FIR - Lombardi, M IR - Lombardi M FIR - Sicari, R IR - Sicari R FIR - Scholte, A J IR - Scholte AJ FIR - Zamorano, J L IR - Zamorano JL FIR - Kaufmann, P A IR - Kaufmann PA FIR - Underwood, S R IR - Underwood SR FIR - Knuuti, J IR - Knuuti J EDAT- 2019/11/09 06:00 MHDA- 2021/06/29 06:00 CRDT- 2019/11/09 06:00 PHST- 2019/05/15 00:00 [received] PHST- 2019/09/06 00:00 [revised] PHST- 2019/10/25 00:00 [accepted] PHST- 2019/11/09 06:00 [pubmed] PHST- 2021/06/29 06:00 [medline] PHST- 2019/11/09 06:00 [entrez] AID - 5614586 [pii] AID - 10.1093/ehjci/jez248 [doi] PST - ppublish SO - Eur Heart J Cardiovasc Imaging. 2020 Oct 20;21(11):1273-1282. doi: 10.1093/ehjci/jez248.