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FFR Derived From Coronary CT Angiography in Nonculprit Lesions of Patients With Recent STEMI
Sara Gaur1, Charles A Taylor2, Jesper M Jensen1
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Noninvasive fractional flow reserve (FFRCT) shows moderate diagnostic performance for detecting ischemia in nonculprit vessels after ST-segment elevation myocardial infarction (STEMI). Its accuracy is influenced by vessel size, suggesting it is not routinely recommended post-STEMI.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Performance Evaluation
Background:
- Fractional flow reserve derived from coronary computed tomography angiography (FFRCT) is effective for diagnosing ischemia in stable angina patients.
- The utility of FFRCT in assessing multivessel disease in ST-segment elevation myocardial infarction (STEMI) patients remains unevaluated.
Purpose of the Study:
- To assess the diagnostic performance of FFRCT for identifying lesion-specific ischemia in nonculprit coronary arteries of STEMI patients with multivessel disease.
Main Methods:
- Coronary computed tomography angiography (CTA) and invasive coronary angiography with fractional flow reserve (FFR) were performed one month post-STEMI.
- FFRCT values ≤0.80 were considered indicative of ischemia, with invasive FFR ≤0.80 serving as the reference standard.
- Coronary vessel lumen volume relative to left ventricular mass (volume-to-mass ratio) was calculated to assess vessel size influence.
Main Results:
- FFRCT demonstrated moderate diagnostic performance (72% accuracy, 83% sensitivity, 66% specificity) in 124 nonculprit vessels from 60 STEMI patients.
- Diagnostic performance varied significantly based on the volume-to-mass ratio, with higher accuracy in patients with larger vessel volumes.
- STEMI patients exhibited a lower median volume-to-mass ratio compared to stable angina patients.
Conclusions:
- The diagnostic accuracy of FFRCT for ischemia detection in nonculprit vessels of STEMI patients is moderate and influenced by vessel size.
- The study does not support the routine application of FFRCT in the post-STEMI setting.
- STEMI patients have smaller coronary vessel volumes, impacting FFRCT performance.
Objectives:
This study sought to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) 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, FFRCT has high diagnostic performance in identification of ischemia-causing lesions. The potential value of FFRCT for assessment of multivessel disease in patients with recent STEMI has not been evaluated.
Methods:
Coronary CTA with calculation of FFRCT 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 FFRCT 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 FFRCT 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 mm3/g (p = 0.009). In patients with volume-to-mass ratio ≥65 mm3/g (upper tertile) accuracy, sensitivity, and specificity of FFRCT were all 83% versus 56% (p = 0.009), 75% (p = 0.61), and 44% (p = 0.003) in patients with <49 mm3/g (lower tertile).
Conclusions:
The diagnostic performance of FFRCT 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 FFRCT is influenced by the volume-to-mass ratio. This study does not support routine use of FFRCT in the post-STEMI setting. (Assessment of Coronary Stenoses Using Coronary CT-Angiography and Noninvasive Fractional Flow Reserve; NCT01739075).
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