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Published on: June 28, 2019
Long-term prognostic implications of CT angiography-derived fractional flow reserve: Results from the DISCOVER-FLOW
Seokhun Yang1, Jaewook Chung1, Krista Lesina2
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
Insights
CT angiography-derived fractional flow reserve (FFRCT) effectively predicts long-term cardiac events in stable coronary artery disease. This non-invasive method offers risk stratification comparable to invasive fractional flow reserve (FFR).
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- The long-term prognostic value of CT angiography-derived fractional flow reserve (FFRCT) is not well-established.
- This study investigates the long-term outcomes associated with FFRCT from its initial human trial.
Purpose of the Study:
- To evaluate the long-term prognostic implications of FFRCT in patients with stable coronary artery disease.
- To compare the predictive performance of FFRCT with invasive fractional flow reserve (FFR).
Main Methods:
- A cohort of 102 patients (156 vessels) with stable coronary artery disease underwent coronary CT angiography (CCTA) and invasive FFR measurement.
- The primary endpoint was target vessel failure (TVF), encompassing cardiovascular death, target vessel myocardial infarction, and target vessel revascularization.
- Outcome analysis utilized a marginal Cox proportional hazard model based on FFRCT values.
Main Results:
- Over a median 9.9-year follow-up, 12.8% of vessels experienced TVF.
- FFRCT ≤0.80 was associated with a significantly higher risk of TVF (HR 2.61).
- In vessels managed conservatively, TVF risk showed an inverse correlation with FFRCT, and FFRCT demonstrated predictive accuracy similar to invasive FFR (c-index 0.79 vs 0.71).
Conclusions:
- FFRCT provides robust long-term risk stratification for patients with stable coronary artery disease.
- The risk continuum identified by FFRCT mirrors that of invasive FFR, supporting its clinical utility.
Background & Objectives:
The long-term prognostic implications of CT angiography-derived fractional flow reserve (FFRCT) remains unclear. We aimed to explore the long-term outcomes of FFRCT in the first-in-human study of it.
Materials & Methods:
A total of 156 vessels from 102 patients with stable coronary artery disease, who underwent coronary CT angiography (CCTA) and invasive FFR measurement, were followed. The primary endpoint was target vessel failure (TVF), including cardiovascular death, target vessel myocardial infarction, and target vessel revascularization. Outcome analysis with FFRCT was performed on a per-vessel basis using a marginal Cox proportional hazard model.
Results:
During median 9.9 years of follow-up, TVF occurred in 20 (12.8%) vessels. FFRCT ≤0.80 discriminated TVF (hazard ratio [HR] 2.61, 95% confidence interval [CI] 1.06, 6.45). Among 94 vessels with deferral of percutaneous coronary intervention (PCI), TVF risk was inversely correlated with FFRCT (HR 0.62 per 0.1 increase, 95% CI 0.44, 0.86), with the cumulative incidence of TVF being 2.6%, 15.2%, and 28.6% for vessels with FFRCT >0.90, 0.81-0.90, and ≤0.80, respectively (p-for-trend 0.005). Predictive value for clinical outcomes of FFRCT was similar to that of invasive FFR (c-index 0.79 vs 0.71, P = 0.28). The estimated TVF risk was higher in the deferral of PCI group than the PCI group for vessels with FFRCT ≤0.81.
Conclusion:
FFRCT showed improved long-term risk stratification and displayed a risk continuum similar to invasive FFR.
Clinical Trial Registration:
NCT01189331.
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