Examining the association between cardiovascular outcomes in individuals undergoing percutaneous coronary...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• The clinical utility of coronary CT angiography (CCTA) in patients undergoing percutaneous coronary intervention (PCI) for obstructive coronary artery disease (CAD) is not well-established.
• Optimizing patient selection and management before PCI is crucial for improving cardiovascular outcomes.

Purpose of the Study:

• To evaluate the association between pre-procedural CCTA and long-term outcomes in patients undergoing de novo PCI.
• To determine if CCTA influences rates of mortality, myocardial infarction (MI), or heart failure (HF) after PCI.

Main Methods:

• Retrospective cohort study using the TriNetX U.S. Research Network (2013-2025).
• Included adults undergoing de novo PCI, excluding those with prior interventions or acute coronary syndrome.
• 1:1 propensity score matching compared patients with CCTA within 1 year before PCI to those without (n=4936 per group).
• Primary outcome: composite of all-cause mortality, MI, or HF at 1 and 5 years.

Main Results:

• Post-matching, baseline characteristics were well-balanced between groups.
• CCTA prior to PCI was associated with significantly lower composite outcomes at 1 year (9.6% vs. 13.0%) and 5 years (16.1% vs. 23.7%).
• Reductions in MI and mortality drove the composite outcome benefit. Heart failure rates were similar at 1 year but lower at 5 years with CCTA.

Conclusions:

• Pre-procedural CCTA within one year of PCI is linked to improved cardiovascular outcomes at both 1 and 5 years.
• These findings suggest CCTA may benefit patients by enabling better anatomical assessment and medical optimization before revascularization.
• Further research could explore the mechanisms behind these improved outcomes.