Clinical outcomes following real-world computed tomography angiography-derived fractional flow reserve testing in chronic coronary syndrome patients with calcification
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Clinical outcomes following real-world computed tomography angiography-derived fractional flow reserve testing in chronic coronary syndrome patients with calcification. / Nørgaard, Bjarne L; Mortensen, Martin B; Parner, Erik; Leipsic, Jonathon; Steffensen, Flemming H; Grove, Erik Lerkevang; Mathiassen, Ole N; Sand, Niels Peter; Pedersen, Kamilla; Riedl, Katharina A; Engholm, Morten; Bøtker, Hans Erik; Jensen, Jesper M.
In: EUR HEART J-CARD IMG, Vol. 22, No. 10, 20.09.2021, p. 1182-1189.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Clinical outcomes following real-world computed tomography angiography-derived fractional flow reserve testing in chronic coronary syndrome patients with calcification
AU - Nørgaard, Bjarne L
AU - Mortensen, Martin B
AU - Parner, Erik
AU - Leipsic, Jonathon
AU - Steffensen, Flemming H
AU - Grove, Erik Lerkevang
AU - Mathiassen, Ole N
AU - Sand, Niels Peter
AU - Pedersen, Kamilla
AU - Riedl, Katharina A
AU - Engholm, Morten
AU - Bøtker, Hans Erik
AU - Jensen, Jesper M
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2021/9/20
Y1 - 2021/9/20
N2 - AIMS: This study sought to investigate outcomes following a normal CT-derived fractional flow reserve (FFRCT) result in patients with moderate stenosis and coronary artery calcification, and to describe the relationship between the extent of calcification, stenosis, and FFRCT.METHODS AND RESULTS: Data from 975 consecutive patients suspected of chronic coronary syndrome with stenosis (30-70%) determined by computed CT angiography and FFRCT to guide downstream management decisions were reviewed. Median (range) follow-up time was 2.2 (0.5-4.2) years. Coronary artery calcium (CAC) scores were ≥400 in 25%, stenosis ≥50% in 83%, and FFRCT >0.80 in 51% of the patients. There was a lower incidence of the composite endpoint (death, myocardial infarction, hospitalization for unstable angina, and unplanned coronary revascularization) at 4.2 years in patients with any CAC and FFRCT > 0.80 vs. FFRCT ≤ 0.80 (3.9% and 8.7%, P = 0.04), however, in patients with CAC scores ≥400 the risk difference between groups did not reach statistical significance, 4.2% vs. 9.7% (P = 0.24). A negative relationship between CAC scores and FFRCT irrespective of stenosis severity was demonstrated.CONCLUSION: FFRCT shows promise in identifying patients with stenosis and calcification who can be managed without further downstream testing. Moreover, an inverse relationship between CAC levels and FFRCT was demonstrated. Studies are needed to further assess the clinical utility of FFRCT in patients with extensive coronary calcification.
AB - AIMS: This study sought to investigate outcomes following a normal CT-derived fractional flow reserve (FFRCT) result in patients with moderate stenosis and coronary artery calcification, and to describe the relationship between the extent of calcification, stenosis, and FFRCT.METHODS AND RESULTS: Data from 975 consecutive patients suspected of chronic coronary syndrome with stenosis (30-70%) determined by computed CT angiography and FFRCT to guide downstream management decisions were reviewed. Median (range) follow-up time was 2.2 (0.5-4.2) years. Coronary artery calcium (CAC) scores were ≥400 in 25%, stenosis ≥50% in 83%, and FFRCT >0.80 in 51% of the patients. There was a lower incidence of the composite endpoint (death, myocardial infarction, hospitalization for unstable angina, and unplanned coronary revascularization) at 4.2 years in patients with any CAC and FFRCT > 0.80 vs. FFRCT ≤ 0.80 (3.9% and 8.7%, P = 0.04), however, in patients with CAC scores ≥400 the risk difference between groups did not reach statistical significance, 4.2% vs. 9.7% (P = 0.24). A negative relationship between CAC scores and FFRCT irrespective of stenosis severity was demonstrated.CONCLUSION: FFRCT shows promise in identifying patients with stenosis and calcification who can be managed without further downstream testing. Moreover, an inverse relationship between CAC levels and FFRCT was demonstrated. Studies are needed to further assess the clinical utility of FFRCT in patients with extensive coronary calcification.
KW - Computed Tomography Angiography
KW - Coronary Angiography
KW - Coronary Artery Disease/diagnostic imaging
KW - Coronary Stenosis/diagnostic imaging
KW - Coronary Vessels
KW - Fractional Flow Reserve, Myocardial
KW - Humans
KW - Predictive Value of Tests
KW - Severity of Illness Index
KW - Tomography, X-Ray Computed
U2 - 10.1093/ehjci/jeaa173
DO - 10.1093/ehjci/jeaa173
M3 - SCORING: Journal article
C2 - 32793947
VL - 22
SP - 1182
EP - 1189
JO - EUR HEART J-CARD IMG
JF - EUR HEART J-CARD IMG
SN - 2047-2404
IS - 10
ER -
