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Clinical and prognostic incremental value of FFRCT in screening of patients with obstructive coronary artery disease

医学 狼牙棒 部分流量储备 冠状动脉疾病 心脏病学 内科学 狭窄 放射科 血运重建 冠状动脉造影 心肌梗塞 经皮冠状动脉介入治疗
作者
Jean‐François Argacha,Andreea Motoc,Johanna Lammens,Bert Vandeloo,Kaoru Tanaka,Dries Belsack,Vincent Michiels,Stijn Lochy,Toshimitsu Tsugu,Tom De Potter,Yves Thorrez,Julien Magné,Johan De Mey,Bernard Cosyns
出处
期刊:Journal of Cardiovascular Computed Tomography [Elsevier BV]
卷期号:18 (1): 62-68 被引量:2
标识
DOI:10.1016/j.jcct.2023.11.078
摘要

Abstract

Background

Coronary computed tomography angiography (CCTA) -derived fractional flow reserve (FFRCT) is recommended to evaluate the functional consequences of obstructive coronary artery disease (OCAD). Real-world incremental impacts of FFRCT use still remains under debate.

Methods

1601 patients with suspected OCAD on CCTA (>50 ​% stenosis), including 808 (50.5 ​%) patients evaluated by FFRCT, were included from a 2013–2021 registry. Propensity adjusted impacts of FFRCT use on rates of invasive coronary angiography (ICA), myocardial revascularization (MR) and post MR major adverse cardiac events (MACE) were reported, including a sensitivity analysis in severe OCAD (>70 ​% stenosis) (n ​= ​450). Accuracy of numerical and comprehensive FFRCT interpretations in selection of patients requiring a MR were also compared.

Results

1160 (72,5 ​%) ICA, 559 (34.9 ​%) MR and 137 (24.5 ​%) post MR MACE occurred at 4.7 ​± ​1.9 years. FFRCT use was independently associated with decreased rate of ICA and MR (OR: 0.66; 95 ​% CI 0.53–0.83, p ​< ​0.001 and OR: 0.71; 95 ​% CI 0.58–0.88, p ​< ​0.01, respectively). Compared to the numerical interpretation, the FFRCT comprehensive assessment increased the ratio of MR per ICA (61.7 ​% vs 50.1 ​%, p ​< ​0.01) and was more accurate in selection of patients requiring MR. FFRCT reduced post MR MACE (OR: 0.64; 95 ​% CI 0.43–0.96, p ​< ​0.05). All these associations were no longer observed in severe OCAD.

Conclusion

Implementing FFRCT in OCAD patients reduces ICA use, improves selection of patients requiring MR and reduces post MR MACE. However, these incremental values of FFRCT were no longer observed in severe OCAD.
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