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Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with

Kristian T Madsen1, Bjarne L Nørgaard1, Kristian A Øvrehus1

  • 1From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.).

Radiology
|September 12, 2023
PubMed

Insights

A normal coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR) test reliably predicts a low 3-year risk of death or heart attack in stable angina patients, including those with high coronary artery calcium (CAC).

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Diagnostic Accuracy

Background:

  • The prognostic significance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR) beyond one year, particularly in patients with high coronary artery calcium (CAC), remains unclear.
  • Accurate risk stratification is crucial for managing patients with coronary stenosis and stable angina pectoris.

Purpose of the Study:

  • To evaluate the 3-year prognostic value of coronary CTA-derived FFR results for clinical outcomes in patients with coronary stenosis.
  • To specifically assess this prognostic value in a subgroup of patients characterized by high levels of CAC.

Main Methods:

  • A 3-year follow-up of 900 patients with stable angina enrolled in the ADVANCE registry (ClinicalTrials.gov: NCT02499679).
  • Coronary CTA-derived FFR was assessed, with abnormal results defined as a value ≤0.80.
  • High CAC was defined as an Agatston score ≥400. The primary endpoint was a composite of all-cause death and nonfatal spontaneous myocardial infarction.

Main Results:

  • The primary endpoint occurred in 2.1% of patients with normal CTA-derived FFR versus 6.6% with abnormal results (Relative Risk [RR] 3.1; P < .001).
  • In the high CAC subgroup, the primary endpoint occurred in 2.2% with normal CTA-derived FFR versus 9.0% with abnormal results (RR 4.1; P = .001).
  • A normal CTA-derived FFR result was associated with significantly lower rates of the primary endpoint in both the overall cohort and the high CAC subgroup.

Conclusions:

  • In patients with stable angina, a normal coronary CTA-derived FFR result effectively identifies individuals at low risk for 3-year adverse cardiovascular events (death or myocardial infarction).
  • This finding holds true for the general cohort and specifically for patients with high CAC scores, supporting its utility in risk stratification.

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