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

被引:27
作者
Becker, Leonie M. [1 ,2 ]
Peper, Joyce [1 ,2 ]
Verhappen, Bram J. L. A. [1 ]
Swart, Laurens A. [3 ]
Dedic, Admir [4 ]
van Dockum, Willem G. [5 ]
van der Ent, Martin [5 ]
Royaards, Kees-Jan [5 ]
Niezen, Andre [6 ]
Hensen, Jan-Hein J. [6 ]
van Kuijk, Jan-Peter [1 ]
Mohamed Hoesein, Firdaus A. A. [2 ]
Leiner, Tim [2 ,7 ]
Bruning, Tobias A. [5 ]
Swaans, Martin J. [1 ]
机构
[1] St Antonius Hosp, Dept Cardiol, Koekoekslaan 1, NL-3435 CM Nieuwegein, Netherlands
[2] Univ Med Ctr Utrecht, Dept Radiol, Utrecht, Netherlands
[3] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands
[4] Noordwest Ziekenhuisgrp, Dept Cardiol, Alkmaar, Netherlands
[5] Maasstad Hosp, Dept Cardiol, Rotterdam, Netherlands
[6] Maasstad Hosp, Dept Radiol, Rotterdam, Netherlands
[7] Mayo Clin Rochester Minnesota, Dept Radiol, Rochester, MN USA
关键词
Stable angina; Coronary artery disease; Computed tomography angiography; Fractional flow reserve; myocardial; Coronary angiography; FRACTIONAL FLOW RESERVE; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; STABLE CHEST-PAIN; SCCT GUIDELINES; FOLLOW-UP; MANAGEMENT; PERFORMANCE; STENOSIS; INTERVENTION; OUTCOMES;
D O I
10.1007/s00330-023-09517-z
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
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.
引用
收藏
页码:5465 / 5475
页数:11
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