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. 2023 Aug;33(8):5465-5475.
doi: 10.1007/s00330-023-09517-z. Epub 2023 Mar 15.

Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis - IMPACT FFR study

Leonie M Becker  1   2 , Joyce Peper  3   4 , Bram J L A Verhappen  3 , Laurens A Swart  5 , Admir Dedic  6 , Willem G van Dockum  7 , Martin van der Ent  7 , Kees-Jan Royaards  7 , André Niezen  8 , Jan-Hein J Hensen  8 , Jan-Peter van Kuijk  3 , Firdaus A A Mohamed Hoesein  4 , Tim Leiner  4   9 , Tobias A Bruning  7 , Martin J Swaans  3
Affiliations

Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis - IMPACT FFR study

Leonie M Becker et al. Eur Radiol. 2023 Aug.

Abstract

Objectives: The addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of coronary CT angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD).

Methods: This retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACEs) during the 1-year follow-up using chi-square tests for independence. Kaplan-Meier curves were used to visualize the occurrence of safety outcomes over time.

Results: A total of 360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group, and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA group, and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA), and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA, and three (2.2%) SPECT (p < 0.001 for all three options). The revascularization rate after ICA was similar between groups (p = 0.15). However, patients in the CCTA group more often underwent revascularization (p = 0.007).

Conclusion: Addition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after 1 year.

Key points: • Previous studies have shown that computed tomography-derived fractional flow reserve improves the accuracy of coronary computed tomography angiography without changes in acquisition protocols. • This study shows that use of computed tomography-derived fractional flow reserve as gatekeeper to invasive coronary angiography in patients suspected of stable coronary artery disease leads to less invasive testing and revascularization without observed difference in outcomes after 1 year. • This could lead to a significant reduction in costs, complications and (retrospectively unnecessary) usage of diagnostic testing capacity, and a significant increase in patient satisfaction.

Keywords: Computed tomography angiography; Coronary angiography; Coronary artery disease; Fractional flow reserve, myocardial; Stable angina.

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Conflict of interest statement

Dr. L. Swart is a member of the editorial board of European Radiology. He had no influence on the peer review process or acceptance of this manuscript.

Figures

Fig. 1
Fig. 1
Inclusion flow chart. Flow chart of the selection of cases for analysis. Values are presented as n. CCTA, coronary computed tomography angiography; FFR-CT, computed tomography derived fractional flow reserve
Fig. 2
Fig. 2
Example of significant stenosis on CCTA and negative FFR-CT result. a CCTA images of anatomically significant left anterior descending artery (LAD)-stenosis with maximal diameter reduction (max DS) 56%. b FFR-CT results for this CCTA. FFR-CT value after stenosis 0.83, which is negative for ischemia on FFR-CT. The red arrow points to the stenosis in all images. The patient was successfully treated with OMT only and was referred back to their general practitioner
Fig. 3
Fig. 3
Clinical management by diagnostic strategy. Values are presented as n (%). CABG, coronary artery bypass grafting; CCTA, coronary computed tomography angiography; FFR-CT, computed tomography–derived fractional flow reserve; ICA, invasive coronary angiography; MACEs, major cardiovascular events; OMT, optimal medical treatment; PCI, percutaneous coronary intervention
Fig. 4
Fig. 4
Time-to-event curve for major cardiovascular events. Shown is the time-to-event Kaplan–Meier curve of major cardiovascular events (MACEs). CCTA, coronary computed tomography angiography; FFR-CT, computed tomography derived FFR
See this image and copyright information in PMC

References

    1. Neumann FJ, Sechtem U, Banning AP, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–477. doi: 10.1093/eurheartj/ehz425. - DOI - PubMed
    1. Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease. Results from the prospective multicenter accuracy (assessment by coronary computed tomographic angiography of individuals undergoing invasive coronary angiography) trial. J Am Coll Cardiol. 2008;52(21):1724–1732. doi: 10.1016/j.jacc.2008.07.031. - DOI - PubMed
    1. Pijls NHJ, Fearon WF, Tonino PAL, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-Year follow-up of the FAME (fractional flow reserve versus angiography for multivessel evaluation) study. J Am Coll Cardiol. 2010;56(3):177–184. doi: 10.1016/j.jacc.2010.04.012. - DOI - PubMed
    1. Bech GJW, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001;103(24):2928–2934. doi: 10.1161/01.CIR.103.24.2928. - DOI - PubMed
    1. Peper J, Schaap J, Kelder JC, et al. Added value of computed tomography fractional flow reserve in the diagnosis of coronary artery disease. Sci Rep. 2021;11(1):1–9. doi: 10.1038/s41598-021-86245-8. - DOI - PMC - PubMed

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