Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease. Journal Article

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Authors: Rabbat, M; Leipsic, J; Bax, J; Kauh, B; Verma, R; Doukas, D; Allen, S; Pontone, G; Wilber, D; Mathew, V; Rogers, C; Lopez, J
Article Title: Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease.
Abstract: OBJECTIVES: In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFR) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFR could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone. METHODS: The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFR and 44 control patients who underwent CTA alone. Lesions with 30-90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFR. Nadir FFR = 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded. RESULTS: Using coronary CTA and selective FFR, 121 patients (32%) had at least one vessel with =50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFR = 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30-50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFR = 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFR reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFR, no major adverse cardiac events occurred over a mean follow-up of 440 days. CONCLUSION: FFR safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.
Journal Title: Journal of clinical medicine
ISSN: 2077-0383; 2077-0383
Publisher: Unknown  
Date Published: 2020