Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis – IMPACT FFR study

医学 部分流量储备 冠状动脉疾病 神经组阅片室 介入放射学 放射科 血运重建 回顾性队列研究 队列 血管造影 内科学 心脏病学 冠状动脉造影 心肌梗塞 神经学 精神科
作者
Leonie M. Becker,Joyce Peper,Bram J. L. A. Verhappen,Laurens A. Swart,Admir Dedic,Willem G. van Dockum,Martin van der Ent,Kees-Jan Royaards,André Niezen,Jan-Hein J. Hensen,Jan‐Peter van Kuijk,Firdaus A. A. Mohamed Hoesein,Tim Leiner,Tobias A. Bruning,Martin J. Swaans
出处
期刊:European Radiology [Springer Science+Business Media]
卷期号:33 (8): 5465-5475 被引量:5
标识
DOI:10.1007/s00330-023-09517-z
摘要

The addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of coronary CT angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD).This retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACEs) during the 1-year follow-up using chi-square tests for independence. Kaplan-Meier curves were used to visualize the occurrence of safety outcomes over time.A total of 360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group, and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA group, and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA), and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA, and three (2.2%) SPECT (p < 0.001 for all three options). The revascularization rate after ICA was similar between groups (p = 0.15). However, patients in the CCTA group more often underwent revascularization (p = 0.007).Addition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after 1 year.• Previous studies have shown that computed tomography-derived fractional flow reserve improves the accuracy of coronary computed tomography angiography without changes in acquisition protocols. • This study shows that use of computed tomography-derived fractional flow reserve as gatekeeper to invasive coronary angiography in patients suspected of stable coronary artery disease leads to less invasive testing and revascularization without observed difference in outcomes after 1 year. • This could lead to a significant reduction in costs, complications and (retrospectively unnecessary) usage of diagnostic testing capacity, and a significant increase in patient satisfaction.
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