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Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary
Mark Rabbat1, Jonathon Leipsic2, Jeroen Bax3
1Division of Cardiology, Loyola University Medical Center, Maywood, IL 60153, USA.
Insights
Fractional flow reserve from coronary computed tomography angiography (FFRCT) safely reduced invasive coronary angiography (ICA) in patients with coronary artery disease. This strategy deferred unnecessary procedures, with no major adverse cardiac events observed.
Area of Science:
- Cardiovascular Imaging and Intervention
- Non-invasive Cardiac Diagnostics
- Computational Fluid Dynamics in Cardiology
Background:
- Coronary computed tomography angiography (CTA) is increasingly used for diagnosing coronary artery disease (CAD).
- The clinical utility and safety of integrating fractional flow reserve derived from CTA (FFRCT) in real-world practice remain under investigation.
- Determining the feasibility of FFRCT to guide management decisions is crucial for optimizing patient care.
Purpose of the Study:
- To assess the real-world feasibility and outcomes of using FFRCT in patients with suspected CAD.
- To determine if a strategy combining CTA and FFRCT can safely reduce the need for invasive coronary angiography (ICA) compared to CTA alone.
- To evaluate the rate of revascularization and major adverse cardiac events in patients managed with FFRCT.
Main Methods:
- A prospective study involving 387 patients undergoing CTA with selective FFRCT and 44 controls undergoing CTA alone.
- Lesions with 30-90% diameter stenosis underwent FFRCT analysis; a nadir FFRCT ≤ 0.80 indicated functional significance.
- Rates of ICA, revascularization, and major adverse cardiac events were recorded for comparative analysis.
Main Results:
- The combined CTA and FFRCT strategy significantly reduced ICA rates (45% vs. 80%) in patients with obstructive CAD compared to CTA alone.
- In patients with intermediate stenoses (30-50%), FFRCT identified functionally significant lesions in 31%, leading to ICA in only 9%.
- No major adverse cardiac events were reported during a mean follow-up of 440 days in the FFRCT group, demonstrating safety.
Conclusions:
- FFRCT is a safe and effective tool for deferring invasive coronary angiography in patients with CAD of indeterminate hemodynamic significance.
- The integration of FFRCT into clinical practice can optimize the selection of patients requiring revascularization.
- This approach enhances diagnostic accuracy and potentially reduces healthcare costs associated with unnecessary invasive procedures.
Objectives:
In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFRCT) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFRCT could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone.
Methods:
The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFRCT and 44 control patients who underwent CTA alone. Lesions with 30-90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFRCT. Nadir FFRCT ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded.
Results:
Using coronary CTA and selective FFRCT, 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFRCT ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30-50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFRCT ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFRCT reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFRCT, no major adverse cardiac events occurred over a mean follow-up of 440 days.
Conclusion:
FFRCT safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.
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