Clinical Use of Coronary CTA-Derived FFR for Decision-Making in Stable CAD

Bjarne L Nørgaard, Jakob Hjort, Sara Gaur, Nicolaj Hansson, Hans Erik Bøtker, Jonathon Leipsic, Ole N Mathiassen, Erik L Grove, Kamilla Pedersen, Evald H Christiansen, Anne Kaltoft, Lars C Gormsen, Michael Mæng, Christian J Terkelsen, Steen D Kristensen, Lars R Krusell, Jesper Møller Jensen

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Abstract

OBJECTIVES: The goal of this study was to assess the real-world clinical utility of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) for decision-making in patients with stable coronary artery disease (CAD).

BACKGROUND: FFRCT has shown promising results in identifying lesion-specific ischemia. The real-world feasibility and influence on the diagnostic work-up of FFRCT testing in patients suspected of having CAD are unknown.

METHODS: We reviewed the complete diagnostic work-up of nonemergent patients referred for coronary computed tomography angiography over a 12-month period at Aarhus University Hospital, Denmark, including all patients with new-onset chest pain with no known CAD and with intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred for FFRCT. The study evaluated the consequences on downstream diagnostic testing, the agreement between FFRCT and invasively measured FFR or instantaneous wave-free ratio (iFR), and the short-term clinical outcome after FFRCT testing.

RESULTS: Among 1,248 patients referred for computed tomography angiography, 189 patients (mean age 59 years; 59% male) were referred for FFRCT, with a conclusive FFRCT result obtained in 185 (98%). FFRCT was ≤0.80 in 31% of patients and 10% of vessels. After FFRCT testing, invasive angiography was performed in 29%, with FFR measured in 19% and iFR in 1% of patients (with a tendency toward declining FFR-iFR guidance during the study period). FFRCT ≤0.80 correctly classified 73% (27 of 37) of patients and 70% (37 of 53) of vessels using FFR ≤0.80 or iFR ≤0.90 as the reference standard. In patients with FFRCT >0.80 being deferred from invasive coronary angiography, no adverse cardiac events occurred during a median follow-up period of 12 (range 6 to 18 months) months.

CONCLUSIONS: FFRCT testing is feasible in real-world symptomatic patients with intermediate-range stenosis determined by coronary computed tomography angiography. Implementation of FFRCT for clinical decision-making may influence the downstream diagnostic workflow of patients. Patients with an FFRCT value >0.80 being deferred from invasive coronary angiography have a favorable short-term prognosis.

Original languageEnglish
JournalJACC: Cardiovascular Imaging
Volume10
Issue5
Pages (from-to)541-550
Number of pages10
ISSN1936-878X
DOIs
Publication statusPublished - May 2017

Keywords

  • computed tomography angiography
  • coronary angiography
  • coronary artery disease
  • fractional flow reserve
  • Predictive Value of Tests
  • Prognosis
  • Humans
  • Middle Aged
  • Hospitals, University
  • Male
  • Computed Tomography Angiography
  • Feasibility Studies
  • Coronary Artery Disease/diagnostic imaging
  • Fractional Flow Reserve, Myocardial
  • Clinical Decision-Making
  • Aged, 80 and over
  • Denmark
  • Adult
  • Female
  • Aged
  • Coronary Vessels/diagnostic imaging
  • Coronary Angiography/methods

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