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Coronary CT-based FFR in patients with acute myocardial infarction might predict follow-up invasive FFR: The XPECT-MI
Melinda Boussoussou1, István F Édes2, Fanni Nowotta2
1Heart and Vascular Center, Semmelweis University, 68 Városmajor St, 1122, Budapest, Hungary; MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, 68 Városmajor St, 1122, Budapest, Hungary.
Insights
Fractional flow reserve (FFR) in non-infarction related lesions of ST-elevation myocardial infarction (STEMI) patients changes over time. Coronary CT angiography-derived FFR (FFRCT) accurately identifies significant lesions, aiding in treatment decisions.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Biomedical Engineering
Background:
- Assessing non-infarction related (non-IRA) lesions in ST-elevation myocardial infarction (STEMI) patients is crucial.
- Invasive fractional flow reserve (FFRi) is used to evaluate lesion severity, but its changes over time in non-IRA lesions are not well understood.
Purpose of the Study:
- To evaluate changes in FFRi of non-IRA lesions over time in STEMI patients.
- To assess the diagnostic performance of coronary CT angiography-derived FFR (FFRCT) in predicting follow-up FFRi.
Main Methods:
- Prospective enrollment of 38 STEMI patients.
- Baseline and follow-up FFRi measurements (at 45-60 days).
- Baseline FFRCT performed within 10 days of STEMI.
Main Results:
- FFRi values showed a significant difference between baseline and follow-up (p=0.04).
- FFRCT demonstrated a strong correlation with follow-up FFRi (ρ=0.86) with less bias compared to baseline FFRi.
- FFRCT achieved 94.7% accuracy in identifying significant lesions (≤0.8) on follow-up FFRi.
Conclusions:
- Early FFRCT in STEMI patients accurately identifies hemodynamically relevant non-IRA lesions.
- FFRCT shows higher accuracy than baseline FFRi for predicting significant lesions.
- Early FFRCT may enhance cardiac CT applications for identifying patients benefiting from staged revascularization.
Background:
We aimed to evaluate whether invasive fractional flow reserve (FFRi) of non-infarction related (non-IRA) lesions changes over time in ST-elevation myocardial infarction (STEMI) patients. Moreover, we assessed the diagnostic performance of coronary CT angiography-derived FFR(FFRCT) following the index event in predicting follow-up FFRi.
Methods:
We prospectively enrolled 38 STEMI patients (mean age 61.6 ± 9 years, 23.1% female) who underwent non-IRA baseline and follow-up FFRi measurements and a baseline FFRCT (within ≤10 days after STEMI). Follow-up FFRi was performed at 45-60 days (FFRi and FFRCT value of ≤0.8 was considered positive).
Results:
FFRi values showed significant difference between baseline and follow-up (median and interquartile range (IQR) 0.85 [0.78-0.92] vs. 0.81 [0.73-0.90] p = 0.04, respectively). Median FFRCT was 0.81 [0.68-0.93]. In total, 20 lesions were positive on FFRCT. A stronger correlation and smaller bias were found between FFRCT and follow-up FFRi (ρ = 0.86,p < 0.001,bias:0.01) as compared with baseline FFRi (ρ = 0.68, p < 0.001,bias:0.04). Comparing follow-up FFRi and FFRCT, no false negatives but two false positive cases were found. The overall accuracy was 94.7%, with sensitivity and specificity of 100.0% and 90.0% for identifying lesions ≤0.8 on FFRi. Accuracy, sensitivity, and specificity were 81.5%, 93.3%, and 73.9%, respectively, for identifying significant lesions on baseline FFRi using index FFRCT.
Conclusion:
FFRCT in STEMI patients close to the index event could identify hemodynamically relevant non-IRA lesions with higher accuracy than FFRi measured at the index PCI, using follow-up FFRi as the reference standard. Early FFRCT in STEMI patients might represent a new application for cardiac CT to improve the identification of patients who benefit most from staged non-IRA revascularization.
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