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Coronary Artery Bypass Grafting Based on Computed Tomography-Derived Fractional Flow Reserve vs Angiography
Min-Seok Kim1, Ah-Jin Ryu2, Jung Won Kim3
1Cardiovascular Center, Myongji Hospital, Gyeonggido, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea.
Insights
Computed tomography-derived fractional flow reserve (CT-FFR) guided revascularization led to fewer competitive grafts compared to quantitative coronary angiography (QCA). This study found CT-FFR improved graft patency in early outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Randomized trial comparing 1-year outcomes of CT-FFR versus QCA guided revascularization.
- Early analysis focused on angiographic and clinical outcomes.
Purpose of the Study:
- To compare early angiographic and clinical outcomes between CT-FFR and QCA guided coronary artery bypass grafting.
- To evaluate the impact of CT-FFR on graft patency and revascularization success.
Main Methods:
- 106 patients randomized to CT-FFR (N=53) or QCA (N=53) guided CABG.
- Complete revascularization criteria: CT-FFR ≤0.78 or QCA stenosis (>70% left, ≥90% right coronary arteries).
- Angiography performed on postoperative day 1; graft flow categorized (perfectly patent, competitive, occluded).
Main Results:
- No significant difference in patient characteristics or average number of revascularized arteries.
- Significantly higher number of perfectly patent grafts in the CT-FFR group (85.2%) compared to QCA group (72.7%) (p=0.007).
- No operative mortality or differences in morbidities between groups.
Conclusions:
- CT-FFR guided revascularization resulted in a significantly reduced number of competitive grafts compared to QCA.
- Early outcomes suggest improved graft patency with CT-FFR guidance.
Background:
This randomized trial was designed to compare 1-year outcomes in patients who received revascularization on the basis of computed tomography-derived fractional flow reserve (CT-FFR) vs quantitative coronary angiography (QCA). In this early analysis, early angiographic and clinical outcomes were compared.
Methods:
A total of 106 patients were randomized to undergo coronary artery bypass grafting on the basis of CT-FFR (n = 53) or QCA (n = 53). Complete revascularization was achieved for coronary arteries with CT-FFR ≤0.78 (CT-FFR group) or those with QCA stenosis (>70% stenosis for left and ≥90% stenosis for right coronary artery territories; QCA group). Angiography was performed at median 1 (1-1) postoperative day in all patients. Angiographic findings of graft flow were categorized as perfectly patent, competitive (bidirectionally or unidirectionally competitive), or occluded.
Results:
There were no differences in patient characteristics between the groups. The average number of revascularized coronary arteries per patient was 3.7 ± 0.8 in the CT-FFR group and 3.5 ± 0.7 in the QCA group (P = .089). The median difference in expected anastomosis sites was 2 (1-3). There was no operative mortality and no difference in morbidities between the groups. The number of perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts was 167 (85.2%), 10 (5.1%), and 19 (9.7%), respectively, in the CT-FFR group (n = 196) and 133 (72.7%), 23 (12.6%), and 27 (14.8%), respectively, in the QCA group (n = 183). There was a significant difference in the number of perfectly patent grafts between the groups (P = .007).
Conclusions:
The average number of distal anastomoses was similar between the groups. However, the number of competitive grafts was significantly reduced in the CT-FFR group compared with the QCA group.
