FFR Derived From Coronary CT Angiography in Nonculprit Lesions of Patients With Recent STEMI

Sara Gaur, Charles A Taylor, Jesper Møller Jensen, Hans Erik Bøtker, Evald H Christiansen, Anne K Kaltoft, Niels R Holm, Jonathon Leipsic, Christopher K Zarins, Stephan Achenbach, Sophie Khem, Alan Wilk, Hiram G Bezerra, Jens F Lassen, Bjarne L Nørgaard

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

Abstract

Objectives This study sought to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFR CT ) for the diagnosis of lesion-specific ischemia in nonculprit vessels of patients with recent in ST-segment elevation myocardial infarction (STEMI). Background In patients with stable angina, FFR CT has high diagnostic performance in identification of ischemia-causing lesions. The potential value of FFR CT for assessment of multivessel disease in patients with recent STEMI has not been evaluated. Methods Coronary CTA with calculation of FFR CT and invasive coronary angiography with FFR were performed 1 month after STEMI in patients with multivessel disease. Coronary CTA and invasive coronary angiography stenosis >50% were considered obstructive. Lesion-specific ischemia was assumed if FFR CT was ≤0.80. FFR ≤0.80 was the reference standard. To evaluate the influence of vessel size, the total coronary vessel lumen volume relative to left ventricular mass (volume-to-mass ratio) was calculated and compared with that of patients with stable angina. Results The study evaluated 124 nonculprit vessels from 60 patients. Accuracy, sensitivity, and specificity of FFR CT were 72%, 83%, and 66% versus 64% (p = 0.033), 93% (p = 0.15), and 49% (p < 0.001) for CTA and 72% (p = 1.00), 76% (p = 0.46), and 70% (p = 0.54) for invasive coronary angiography. Following STEMI, median volume-to-mass ratio was lower than in patients with stable angina, 53 versus 65 mm 3 /g (p = 0.009). In patients with volume-to-mass ratio ≥65 mm 3 /g (upper tertile) accuracy, sensitivity, and specificity of FFR CT were all 83% versus 56% (p = 0.009), 75% (p = 0.61), and 44% (p = 0.003) in patients with <49 mm 3 /g (lower tertile). Conclusions The diagnostic performance of FFR CT for staged detection of ischemia in STEMI patients with multivessel disease is moderate. STEMI patients have a smaller vessel volume than do patients with stable angina. The diagnostic performance of FFR CT is influenced by the volume-to-mass ratio. This study does not support routine use of FFR CT in the post-STEMI setting. (Assessment of Coronary Stenoses Using Coronary CT-Angiography and Noninvasive Fractional Flow Reserve; NCT01739075)

Original languageEnglish
JournalJACC: Cardiovascular Imaging
Volume10
Issue4
Pages (from-to)424-433
Number of pages10
ISSN1936-878X
DOIs
Publication statusPublished - Apr 2017

Keywords

  • ST-segment elevation myocardial infarction
  • coronary computed tomography angiography
  • fractional flow reserve
  • nonculprit lesion
  • Predictive Value of Tests
  • Reproducibility of Results
  • Prognosis
  • Prospective Studies
  • Humans
  • Middle Aged
  • Male
  • ST Elevation Myocardial Infarction/diagnostic imaging
  • Coronary Artery Disease/complications
  • Computed Tomography Angiography
  • Fractional Flow Reserve, Myocardial
  • Time Factors
  • Female
  • Aged
  • Coronary Vessels/diagnostic imaging
  • Coronary Angiography/methods
  • Percutaneous Coronary Intervention

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