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The clinical utility of FFRCT stratified by age

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  • Malcom Anastasius, University of British Columbia
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  • Paul Maggiore, University of British Columbia
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  • Alex Huang, University of British Columbia
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  • Phillip Blanke, University of British Columbia
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  • Manesh R Patel, Duke University & Duke University Medical Center
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  • Bjarne Linde Nørgaard
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  • Timothy A Fairbairn, University of Liverpool
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  • Koen Nieman, Stanford University
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  • Takashi Akasaka, Wakayama Medical University, Wakayama, Japan.
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  • Daniel S Berman, Cedars Sinai Heart Institute
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  • Gilbert L Raff, Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, Michigan.
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  • Lynne M Hurwitz Koweek, Duke University & Duke University Medical Center
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  • Gianluca Pontone, Centro Cardiologico Monzino, Milan
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  • Tomohiro Kawasaki, Shin Koga Hospital, Fukuoka, Japan.
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  • Niels Peter Rønnow Sand, University of Southern Denmark
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  • Jesper M Jensen
  • Tetsuya Amano, Aichi Medical University, Aichi
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  • Michael Poon, Department of Noninvasive Cardiac Imaging, Northwell Health, New York, New York.
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  • Kristian A Øvrehus, University of Southern Denmark
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  • Jeroen Sonck, Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium., University of Naples Federico II
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  • Mark G Rabbat, Loyola Univ Chicago, Loyola University Chicago, Dept Urol
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  • Sarah Mullen, HeartFlow, Inc., Redwood City, CA, USA.
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  • Bernard De Bruyne, Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis (OLV) Hospital, Aalst, Belgium.
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  • Campbell Rogers, HeartFlow, Inc., Redwood City, CA, USA.
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  • Hitoshi Matsuo, Gifu Heart Center, Gifu, Japan.
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  • Jeroen J Bax, Leiden University Medical Center
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  • Jonathon Leipsic, University of British Columbia

Background: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFR CT) is a safe alternative to invasive coronary angiography. A negative FFR CT has been shown to have low cardiac event rates compared to those with a positive FFR CT. However, the clinical utility of FFR CT according to age is not known. Methods: Patients’ in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFR CT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFR CT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFR CT was deemed to be ≤ 0.8. Results: FFR CT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFR CT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFR CT positivity or stenosis severity <50% or ≥50%. With a negative FFR CT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFR CT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006–1.08, p = 0.02). Amongst patients with a FFR CT > 0.80, there was no effect of age on the odds of revascularisation. Conclusion: The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFR CT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFR CT are largely constant regardless of age.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
Volume15
Issue2
Pages (from-to)121-128
Number of pages8
ISSN1934-5925
DOIs
Publication statusPublished - 1 Mar 2021

    Research areas

  • Age, CT coronary Angiogram, CT fractional Flow reserve, Clinical outcomes, Clinical practice, Coronary artery disease

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ID: 201773568