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Prognostic Value of Coronary CT Angiography-Derived Quantitative Flow Ratio in Suspected Coronary Artery Disease

Zehang Li1, Shengxian Tu1, Matthew B Matheson1

  • 1From the Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China (Z.L., W.Y., L.Q., F.Y.); College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Z.L.); Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Med-X Research Institute, 1954 Hua Shan Rd, Room 123, Shanghai 200030, China (Z.L., S.T., G.L., Y.C.); Department of Epidemiology, Johns Hopkins University, Baltimore, Md (M.B.M.); InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil (C.E.R., B.R.S.M.); Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (M.Y.C.); German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany (M.D.); and Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md (J.M.M., B.R.S.M., J.A.C.L., A.A.Z.).

Radiology
|December 10, 2024
PubMed

Insights

Coronary CT angiography (CTA)-derived quantitative flow ratio (CT-QFR) predicts major adverse cardiovascular events (MACEs) in suspected coronary artery disease (CAD) patients over 5 years. CT-QFR showed similar prognostic value to invasive methods, but prior percutaneous coronary intervention (PCI) impacted its predictive accuracy.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • The prognostic significance of coronary CT angiography (CTA)-derived quantitative flow ratio (CT-QFR) for long-term outcomes in patients with suspected coronary artery disease (CAD) is not well-established.
  • Comparing CT-QFR with invasive coronary angiography (ICA)/SPECT is crucial for clinical application.

Purpose of the Study:

  • To evaluate the prognostic value of CT-QFR in predicting 5-year major adverse cardiovascular events (MACEs) in patients with suspected CAD.
  • To compare the predictive performance of CT-QFR against ICA/SPECT.
  • To investigate the influence of prior percutaneous coronary intervention (PCI) on the prognostic accuracy of CT-QFR.

Main Methods:

  • Secondary analysis of the prospective international CORE320 study involving 379 participants undergoing coronary CTA and SPECT before ICA.
  • CT-QFR was derived from coronary CTA images; 5-year follow-up data for MACEs were collected.
  • Statistical analyses included Kaplan-Meier curves, multivariable Cox regression, and receiver operating characteristic (ROC) curve analysis to compare CT-QFR and ICA/SPECT.

Main Results:

  • CT-QFR was an independent predictor of 5-year MACEs (hazard ratio, 1.9; P = .04), alongside prior myocardial infarction.
  • MACE-free survival rates were comparable between normal CT-QFR and ICA/SPECT findings (82% vs 80%; P = .45) and abnormal findings (60% vs 57%; P = .40).
  • In patients with prior PCI, CT-QFR demonstrated a significantly lower area under the ROC curve for predicting MACEs compared to those without prior PCI (0.44 vs 0.70; P < .001).

Conclusions:

  • CT-QFR is a valuable independent predictor of long-term MACEs in patients with suspected CAD.
  • CT-QFR exhibits comparable prognostic performance to ICA/SPECT over a 5-year follow-up period.
  • The presence of prior PCI diminishes the predictive accuracy of CT-QFR for MACEs, highlighting a limitation in specific patient populations.

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