Does the Routine Availability of CT–Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?

Curzen, Nicholas P.; Nolan, James; Zaman, Azfar G.; Nørgaard, Bjarne L.; Rajani, Ronak

Abstract

Objectives
This study sought to determine the effect of adding computed tomography–derived fractional flow reserve (FFRCT) data to computed tomography angiographic (CTA) data alone for assessment of lesion severity and patient management in 200 patients with chest pain.

Background
Invasive and noninvasive tests used in the assessment of patients with angina all have disadvantages. The ideal screening test for patients presenting for the first time with chest pain would describe both coronary anatomy and the presence of ischemia and would be readily accessible, low cost, and noninvasive.

Methods
Two hundred patients with stable chest pain underwent CTA for clinical reasons, and FFRCT was calculated. Three experienced interventional cardiologists assessed the CTA result for each patient and by consensus developed a management plan (optimal medical therapy, percutaneous coronary intervention, coronary artery bypass graft surgery, or more information required). FFRCT data for each vessel were then revealed, and the interventional cardiologists made a second plan by consensus, using the same 4 options. The primary endpoint for the study was the difference between the 2 strategies.

Results
Overall, after disclosure of FFRCT data there was a change in the allocated management category on the basis of CTA alone in 72 cases (36%). This difference is explained by a discordance between the CTA- and FFRCT-derived assessments of lesion severity. For example, FFRCT was >0.80 in 13 of 44 vessels (29.5%) graded as having a stenosis >90%. In contrast, FFRCT was ≤0.80 in 17 of 366 vessels (4.6%) graded as having stenosis ≤50%.

Conclusions
This study demonstrates proof of concept that the availability of FFRCT results has a substantial effect on the labeling of significant coronary artery disease and therefore on the management of patients compared to CTA alone. Further studies are needed to determine whether FFRCT has potential as a noninvasive diagnostic and management screening tool for patients with stable chest pain.

Citation

Curzen, N. P., Nolan, J., Zaman, A. G., Nørgaard, B. L., & Rajani, R. (2016). Does the Routine Availability of CT–Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?. JACC: Cardiovascular Imaging, 9(10), 1188-1194. https://doi.org/10.1016/j.jcmg.2015.12.026

• Journal Article Type: Article
• Acceptance Date: Dec 11, 2015
• Online Publication Date: Aug 24, 2016
• Publication Date: 2016-10
• Deposit Date: Nov 30, 2023
• Journal: JACC: Cardiovascular Imaging
• Print ISSN: 1936-878X
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 10
• Pages: 1188-1194
• DOI: https://doi.org/10.1016/j.jcmg.2015.12.026
• Keywords: Cardiology and Cardiovascular Medicine; Radiology, Nuclear Medicine and imaging
• Additional Information: This article is maintained by: Elsevier; Article Title: Does the Routine Availability of CT–Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?; Journal Title: JACC: Cardiovascular Imaging; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jcmg.2015.12.026; Content Type: article; Copyright: © 2016 by the American College of Cardiology Foundation. Published by Elsevier.