Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study. Journal Article

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Authors: Pontone, G; Baggiano, A; Andreini, D; Guaricci, AI; Guglielmo, M; Muscogiuri, G; Fusini, L; Fazzari, F; Mushtaq, S; Conte, E; Calligaris, G; De Martini, S; Ferrari, C; Galli, S; Grancini, L; Ravagnani, P; Teruzzi, G; Trabattoni, D; Fabbiocchi, F; Lualdi, A; Montorsi, P; Rabbat, MG; Bartorelli, AL; Pepi, M
Article Title: Stress Computed Tomography Perfusion Versus Fractional Flow Reserve CT Derived in Suspected Coronary Artery Disease: The PERFECTION Study.
Abstract: OBJECTIVES: This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTA+fractional flow reserve derived from cCTA datasets (FFR) and that of cCTA+static stress-computed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. BACKGROUND: FFR and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. METHODS: A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICA+invasive FFR were evaluated with cCTA, FFR, and stress-CTP. RESULTS: Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTA+FFR showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%, 84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTA+stress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%, 94% and 98%, 87%, 99%, 86%, 92%, respectively. Both FFR and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTA+FFR, and cCTA+CTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTA+FFR and cCTA+CTP versus cCTA alone (p  0.001) but no differences between cCTA+FFR versus cCTA+CTP. CONCLUSIONS: FFR and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.
Journal Title: JACC. Cardiovascular imaging
Publisher: Unknown  
Date Published: 2018