1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT The ADVANCE Registry

被引:231
作者
Patel, Manesh R. [1 ]
Norgaard, Bjarne Linde [2 ]
Fairbairn, Timothy A. [3 ]
Nieman, Koen [4 ,5 ]
Akasaka, Takashi [6 ]
Berman, Daniel S. [7 ]
Raff, Gilbert L. [8 ]
Koweek, Lynne M. Hurwitz [1 ]
Pontone, Gianluca [9 ]
Kawasaki, Tomohiro [10 ]
Sand, Niels Peter Ronnow [11 ]
Jensen, Jesper M. [2 ]
Amano, Tetsuya [12 ]
Poon, Michael [13 ]
Ovrehus, Kristian A. [11 ]
Sonck, Jeroen [14 ,15 ]
Rabbat, Mark G. [16 ]
Mullen, Sarah [17 ]
De Bruyne, Bernard [18 ]
Rogers, Campbell [17 ]
Matsuo, Hitoshi [19 ]
Bax, Jeroen J. [20 ]
Leipsic, Jonathon [21 ]
机构
[1] Duke Univ, Med Ctr, Sch Med, Div Cardiol,Dept Med,Duke Clin Res Inst, Durham, NC 27710 USA
[2] Aarhus Univ Hosp, Dept Cardiol, Aarhus, Denmark
[3] Univ Liverpool, Liverpool Heart & Chest Hosp, Dept Cardiol, Liverpool, Merseyside, England
[4] Stanford Univ, Dept Cardiovasc Med, Stanford, CA 94305 USA
[5] Stanford Univ, Dept Radiol, Stanford, CA 94305 USA
[6] Wakayama Med Univ, Dept Cardiovasc Med, Wakayama, Japan
[7] Cedars Sinai Heart Inst, Dept Imaging, Div Nucl Imaging, Los Angeles, CA USA
[8] Beaumont Acad Heart & Vasc Grp, Div Cardiol, Royal Oak, MI USA
[9] Ctr Cardiol Monzino, Milan, Italy
[10] Shin Koga Hosp, Cardiovasc Ctr, Fukuoka, Japan
[11] Univ Southern Denmark, Univ Hosp SouthWest DK, Inst Reg Hlth Res, Cardiac Res Unit, Odense, Denmark
[12] Aichi Med Univ, Dept Cardiol, Nagakute, Aichi, Japan
[13] Northwell Hlth, Dept Noninvas Cardiac Imaging, New York, NY USA
[14] OLV Clin, Cardiovasc Ctr Aalst, Aalst, Belgium
[15] Univ Naples Federico II, Dept Adv Biomed Sci, Naples, Italy
[16] Loyola Univ, Div Cardiol, Chicago, IL 60611 USA
[17] HeartFlow Inc, Redwood City, CA USA
[18] Onze Lieve Vrouw Hosp, Cardiovasc Ctr, Aalst, Belgium
[19] Gifu Heart Ctr, Dept Cardiovasc Med, Gifu, Japan
[20] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands
[21] Univ British Columbia, St Pauls Hosp, Providence Hlth Care, Dept Radiol, Vancouver, BC, Canada
关键词
clinical outcomes; clinical practice; coronary computed tomography angiography; FFRCT; fractional flow reserve; major adverse cardiac events; FRACTIONAL FLOW RESERVE; CORONARY; ANGIOGRAPHY;
D O I
10.1016/j.jcmg.2019.03.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. BACKGROUND Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. METHODS Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. RESULTS At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFRCT <= 0.80 and in 89 (5.60%) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFRCT <= 0.80 and 12 occurred in those with an FFRCT >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFRCT <= 0.80 compared with 10 (0.60%) patients with an FFRCT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT <= 0.80 compared with patients with an FFRCT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). CONCLUSIONS The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679) (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:97 / 105
页数:9
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