The clinical utility of FFR stratified by age. Journal Article

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Authors: Anastasius, M; Maggiore, P; Huang, A; Blanke, P; Patel, MR; Nørgaard, BL; Fairbairn, TA; Nieman, K; Akasaka, T; Berman, DS; Raff, GL; Hurwitz Koweek, LM; Pontone, G; Kawasaki, T; Rønnow Sand, NP; Jensen, JM; Amano, T; Poon, M; Øvrehus, KA; Sonck, J; Rabbat, MG; Mullen, S; De Bruyne, B; Rogers, C; Matsuo, H; Bax, JJ; Leipsic, J
Article Title: The clinical utility of FFR stratified by age.
Abstract: BACKGROUND: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFR) is a safe alternative to invasive coronary angiography. A negative FFR has been shown to have low cardiac event rates compared to those with a positive FFR. However, the clinical utility of FFR according to age is not known. METHODS: Patients' in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those =65 or 65 years of age. The impact of FFR on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFR data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFR was deemed to be = 0.8. RESULTS: FFR was calculated in 1849 (40.6%) subjects aged 65 and 2704 (59.4%) = 65 years of age. Subjects =65 years were more likely to have anatomic obstructive disease on CTA (=50% stenosis), compared to those aged 65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFR strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those = or 65, regardless of FFR positivity or stenosis severity 50% or =50%. With a negative FFR result, and anatomical stenosis =50%, those = and 65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFR and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006-1.08, p = 0.02). Amongst patients with a FFR > 0.80, there was no effect of age on the odds of revascularisation. CONCLUSION: The findings of this study point to a low risk of MACE events or need for revascularisation in those aged = or 65 with a FFR>0.80, despite the higher incidence of anatomic obstructive CAD in those =65 years. The findings show the clinical usefulness and outcomes of FFR are largely constant regardless of age.
Journal Title: Journal of cardiovascular computed tomography
ISSN: 1876-861X; 1876-861X
Publisher: Unknown  
Date Published: 2020