Distribution of FFRCT in single obstructive coronary stenosis and predictors for major adverse cardiac events: a propensity score matching study
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Published on: September 22, 2020
Xianglan Jin1, Xiangyu Jin2, Xiaoyun Wu1
1Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China.
Insights
Fractional flow reserve derived from computed tomography (FFRCT) identifies significant ischemia in obstructive coronary stenosis. FFRCT values and percutaneous coronary intervention (PCI) impact major adverse cardiac events (MACE) in patients with single-vessel disease.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Diagnostic Accuracy
Background:
- Fractional flow reserve derived from computed tomography (FFRCT) enhances ischemia identification over coronary computed tomography angiography (CCTA).
- Clinical implications of FFRCT values in obstructive stenosis, particularly concerning percutaneous coronary intervention (PCI) and patient outcomes, remain under investigation.
- Understanding FFRCT distribution and its association with major adverse cardiac events (MACE) is crucial for guiding treatment strategies.
Purpose of the Study:
- To analyze the distribution of FFRCT values in patients with single obstructive coronary artery stenosis.
- To explore independent factors predicting MACE in this patient cohort.
- To compare outcomes between patients treated with PCI versus conservative management.
Main Methods:
- Retrospective analysis of adult patients with non-ST-segment elevation acute coronary syndrome undergoing FFRCT assessment.
- Utilized coronary computed tomography angiography (CCTA) data from January 2016 to December 2020.
- Employed propensity score matching (PSM) and Cox proportional hazards regression to evaluate risk factors for MACE.
Main Results:
- A cohort of 655 patients with single obstructive stenosis was analyzed, with 279 receiving PCI and 376 managed conservatively.
- After PSM, significant differences were observed in unstable angina history, Canadian Cardiovascular Society Class (CCSC), and FFRCT between groups.
- The incidence of MACE was lower in the PCI group (14.9%) compared to the conservative group (23.5%) (P=0.020).
- Independent predictors for MACE included history of unstable angina (adjOR, 3.165), FFRCT ≤ 0.8 (OR, 1.632), and PCI therapy (OR, 0.481).
Conclusions:
- History of unstable angina and FFRCT values ≤ 0.8 are independent risk factors for MACE.
- Percutaneous coronary intervention (PCI) therapy emerged as an independent protective factor against MACE.
- FFRCT provides valuable prognostic information in patients with obstructive coronary stenosis.
Background:
Fractional flow reserve derived from computed tomography (FFRCT) has been demonstrated to improve identification of lesion-specific ischemia significantly compared with coronary computed tomography angiography (CCTA). It remains unclear whether the distribution of FFRCT values in obstructive stenosis between patients who received percutaneous coronary intervention (PCI) or not in routine clinical practice, as well as its association with clinical outcome. This study aims to reveal the distribution of FFRCT value in patients with single obstructive coronary artery stenosis and explored the independent factors for predicting major adverse cardiac events (MACE).
Methods:
This was a retrospective study of adults with non-ST-segment elevation acute coronary syndrome undergoing FFRCT assessment by using CCTA data from January 1, 2016 to December 31, 2020. Propensity score matching (PSM) method was used to account for patient selection bias. The risk factors for predicting MACE were evaluated by a Cox proportional hazards regression analysis.
Results:
Overall, 655 patients with single obstructive (≥ 50%) stenosis shown on CCTA were enrolled and divided into PCI group (279 cases) and conservative group (376 cases) according to treatment strategy. The PSM cohort analysis demonstrated that the difference in history of unstable angina, Canadian Cardiovascular Society Class (CCSC) and FFRCT between PCI group (188 cases) and conservative group (315 cases) was statistically significant, with all P values < 0.05, while the median follow-up time between them was not statistically significant (24 months vs. 22.5 months, P = 0.912). The incidence of MACE in PCI group and conservative group were 14.9% (28/188) and 23.5% (74/315) respectively, P = 0.020. Multivariate analysis of Cox proportional hazards regression revealed that history of unstable angina (adjusted odds ratio (adjOR), 3.165; 95% confidence interval (CI), 2.087-4.800; P < 0.001), FFRCT ≤ 0.8 (OR, 1.632;95% CI 1.095-2.431; P = 0.016), and PCI therapy (OR 0.481; 95% CI 0.305-0.758) were the independent factors for MACE.
Conclusions:
History of unstable angina and FFRCT value of ≤ 0.8 were the independent risk factors for MACE, while PCI therapy was the independent protective factor for MACE.
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