Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study.

Aim. To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization inpatients 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 coronaryanatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followedby invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CADwas documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratoryanalysis showed that 134 patients had obstructive CAD by CTCA (>50% stenosis in major coronary vessels) and79 significant ischaemia by functional imaging [>10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstableangina 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 itsabsence 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 CADtargeted to the combined anatomical and functional disease phenotype improves clinical outcome.