Coronary Computed Tomographic Angiography for Selective Cardiac Catheterization - CONSERVE

Jul 08, 2019
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
GE Healthcare and the Leading Foreign Research Institute Recruitment Program of the National Research Foundation of Korea, Ministry of Science, ICT & Future Planning (Seoul, Korea).
Date Published:
07/01/2019
Original Posted Date:
07/08/2019
References

Contribution To Literature:

The CONSERVE trial showed that selective coronary angiography after initial coronary CT angiography was noninferior to routine invasive angiography.

Description:

The goal of the trial was to evaluate a strategy of selective referral for invasive coronary angiography compared with routine invasive coronary angiography among stable patients with suspected coronary artery disease (CAD).

Study Design

  • Randomized
  • Parallel

Patients with suspected obstructive CAD were randomized to selective referral for invasive coronary angiography after initial computed tomography (CT) angiography (n = 823) versus routine invasive coronary angiography (n = 808).

  • Total number of enrollees: 1,611
  • Duration of follow-up: 1 year
  • Mean patient age: 60 years
  • Percentage female: 48%
  • Percentage with diabetes: 26%

Inclusion criteria:

  • Stable patients with suspected CAD due to symptoms or abnormal stress testing

Exclusion criteria:

  • Chronic ischemic heart disease
  • Congenital heart disease
  • Class I indication for invasive coronary angiography

Other salient features/characteristics:

  • Among patients randomized to selective angiography strategy, 95% underwent coronary CT angiography and 23% ultimately had invasive coronary angiography.
  • Among patients randomized to selective angiography strategy, 89% underwent invasive coronary angiography.
  • Rate of percutaneous coronary intervention: 11% of the selective angiography group vs. 15% of the routine angiography group (p < 0.001)
  • Normalcy rate (no obstructive coronary disease): 25% of the selective angiography group vs. 61% of the routine angiography group (p < 0.001)

Principal Findings:

The primary outcome, death, myocardial infarction, unstable angina, cardiac hospitalization, or stroke, occurred in 4.6% of the selective angiography group compared with 4.6% of the routine angiography group (p = 0.026 for noninferiority).

Secondary outcomes:

  • Major bleeding: None in the selective angiography group vs. 0.3% of the routine angiography group
  • Transfusion: None in the selective angiography group vs. 0.1% of the routine angiography group

Interpretation:

Among patients with suspected stable ischemic heart disease, selective invasive coronary angiography after initial coronary CT angiography was noninferior to routine coronary angiography. Major adverse cardiac events were similar between treatment arms. Among patients randomized to selective angiography, invasive coronary angiography was ultimately performed in 23% and coronary revascularization was performed less frequently. A growing body of evidence supports that coronary CT angiography can be used as a gatekeeper for cardiac catheterization procedures.

References:

Chang HJ, Lin FY, Gebow D, et al. Selective Referral Using CCTA Versus Direct Referral for Individuals Referred to Invasive Coronary Angiography for Suspected CAD: A Randomized, Controlled, Open-Label Trial. JACC Cardiovasc Imaging 2019;12:1303-12.

Editorial Comment: Newby DE. CONSERVE Your Energy and Resources. JACC Cardiovasc Imaging 2019;12:1313-5.

Keywords: Angina Pectoris, Angina, Unstable, Blood Transfusion, Cardiac Catheterization, Cardiology Interventions, Coronary Angiography, Coronary Artery Disease, Hemorrhage, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Percutaneous Coronary Intervention, Stroke, Tomography, X-Ray Computed


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