Completeness of revascularization by FFRCT in stable angina: Association to adverse cardiovascular outcomes
Kristian Tækker Madsen1, Bjarne Linde Nørgaard2, Kristian Altern Øvrehus3
1Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark.
Insights
Incomplete revascularization in patients with coronary artery disease, defined by fractional flow reserve computed tomography (FFRCT) ≤ 0.80, is linked to worse cardiovascular outcomes. Complete revascularization significantly improves patient prognosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- The prognostic value of complete coronary revascularization compared to non-invasive testing remains unclear.
- Stable angina management often involves assessing coronary stenosis severity.
Purpose of the Study:
- To evaluate the association between the completeness of coronary revascularization, determined by FFRCT, and cardiovascular outcomes in stable angina patients.
Main Methods:
- A multicenter, 3-year follow-up study included patients with new-onset stable angina and CTA-defined stenosis ≥ 30%.
- Lesion-specific FFRCT was measured; values ≤ 0.80 indicated significant stenosis.
- Patients were categorized into completely revascularized (all significant lesions treated) or incompletely revascularized groups.
Main Results:
- FFRCT ≤ 0.80 was found in 42% of patients. Incomplete revascularization (IR-FFRCT) was associated with a higher risk of cardiovascular death/myocardial infarction compared to complete revascularization (CR-FFRCT) (7.1% vs. 2.4%).
- The risk was significantly higher compared to patients with normal FFRCT (0.6%).
- Non-revascularized vessels with FFRCT ≤ 0.80 had a higher incidence of secondary endpoints than revascularized vessels (12% vs. 1.7%).
Conclusions:
- Incomplete revascularization in patients with FFRCT ≤ 0.80 is linked to adverse cardiovascular outcomes.
- Complete revascularization and normal FFRCT are associated with better prognoses.
Background:
The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.
Objectives:
To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFRCT) and cardiovascular outcomes in patients with stable angina.
Methods:
Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFRCT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFRCT ≤ 0.80 were categorized as: Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤ 0.80 revascularized; incompletely revascularized (IR-FFRCT), ≥ 1 vessels with FFRCT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
Results:
Amongst 900 patients and 1759 vessels, FFRCT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFRCT (15/210 [7.1%]) compared to CR-FFRCT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p = 0.036, and to normal FFRCT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFRCT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFRCT ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFRCT > 0.80 (10/1223 [0.8%]), p < 0.001.
Conclusion:
Incomplete revascularization of patients with lesion-specific FFRCT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFRCT > 0.80.
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