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Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in
Gaurav S Gulsin1, Georgios Tzimas1, Kenneth-Royce Holmes1
1From the Department of Medicine and Radiology, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6T 1Z3 (G.S.G., G.T., K.R.H., H.T., S.L.S., P.B., J.A.L.); Department of Cardiovascular Sciences, University of Leicester and the NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK (G.S.G.); Department of Heart Vessels, Cardiology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (G.T.); Centre for Heart Lung Innovation, University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada (S.L.S., J.A.L.); Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (L.M.H.K., M.R.P.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.J.); Department of Cardiology, Loyola University of Chicago, Chicago, Ill; (M.G.R.); Department of Cardiology, Edward Hines Jr VA Hospital, Hines, Ill (M.G.R.); Department of Cardiology, Centro Cardiologico Monzino, Milan, Italy (G.P.); Department of Cardiology, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool, UK (T.A.F.); Department of Cardiology, Beaumont Health, Royal Oak, Mich (K.M.C.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (P.S.D.); Department of Cardiology, Gifu Heart Center, Gifu, Japan (H.M.); Cardiac Research Unit, Institute of Regional Health Research, University Hospital of SouthWest DK, University of Southern Denmark, Odense, Denmark (N.P.R.S.); Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands (K.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.B.); Department of Cardiology, Aichi Medical University, Aichi, Japan (T. Amano); Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan (T.K.); Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan (T. Akasaka); HeartFlow Inc, Redwood City, Calif (W.H., C.R., S.M.); Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, Calif (D.S.B.); and Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium (B.D.B.).
Purpose:
To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM).
Materials And Methods:
This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM.
Results:
The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%, P < .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%, P < .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%, P < .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1; P = .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity.
Conclusion:
Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679Keywords: Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease Supplemental material is available for this article. See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.
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