TY - JOUR
T1 - Prognostic value of coronary computed tomography angiographic derived fractional flow reserve
T2 - a systematic review and meta-analysis
AU - Nørgaard, Bjarne L
AU - Gaur, Sara
AU - Fairbairn, Timothy A
AU - Douglas, Pam S
AU - Jensen, Jesper M
AU - Patel, Manesh R
AU - Ihdayhid, Abdul R
AU - Ko, Brian S H
AU - Sellers, Stephanie L
AU - Weir-McCall, Jonathan
AU - Matsuo, Hitoshi
AU - Sand, Niels Peter R
AU - Øvrehus, Kristian A
AU - Rogers, Campbell
AU - Mullen, Sarah
AU - Nieman, Koen
AU - Parner, Erik
AU - Leipsic, Jonathon
AU - Abdulla, Jawdat
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/2
Y1 - 2022/2
N2 - Objectives To obtain more powerful assessment of the prognostic value of fractional flow reserve
CT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFR
CT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). Methods We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserve
CT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as’all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. Results Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFR
CT>0.80% and 1.4% (47/3334) with FFR
CT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFR
CT ≤0.80 versus patients with FFR
CT >0.80. Each 0.10-unit FFR
CT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). Conclusions The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFR
CT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFR
CT numerical value was inversely associated with outcomes.
AB - Objectives To obtain more powerful assessment of the prognostic value of fractional flow reserve
CT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFR
CT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). Methods We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserve
CT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as’all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. Results Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFR
CT>0.80% and 1.4% (47/3334) with FFR
CT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFR
CT ≤0.80 versus patients with FFR
CT >0.80. Each 0.10-unit FFR
CT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). Conclusions The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFR
CT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFR
CT numerical value was inversely associated with outcomes.
KW - CT ANGIOGRAPHY
KW - DISEASE
KW - OUTCOMES
KW - SEVERITY
KW - TRIALS
KW - angina pectoris
KW - computed tomography angiography
KW - diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85123399646&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2021-319773
DO - 10.1136/heartjnl-2021-319773
M3 - Review
C2 - 34686567
SN - 1355-6037
VL - 108
SP - 194
EP - 202
JO - Heart
JF - Heart
IS - 3
M1 - heartjnl-2021-319773
ER -