Completeness of revascularization by FFR CT in stable angina: Association to adverse cardiovascular outcomes

• Published in: Journal of cardiovascular computed tomography 2024-09, Vol.18 (5), p.494
• Main Authors: Madsen, Kristian Tækker, Nørgaard, Bjarne Linde, Øvrehus, Kristian Altern, Jensen, Jesper Møller, Parner, Erik, Grove, Erik Lerkevang, Mortensen, Martin B, Iraqi, Nadia, Fairbairn, Timothy A, Nieman, Koen, Patel, Manesh R, Rogers, Campbell, Mullen, Sarah, Mickley, Hans, Thomsen, Kristian Korsgaard, Bøtker, Hans Erik, Leipsic, Jonathon, Rønnow Sand, Niels Peter
• Format: Article
• Language: English
• Subjects: Aged; Angina, Stable - diagnostic imaging; Angina, Stable - mortality; Angina, Stable - physiopathology; Angina, Stable - surgery; Angina, Stable - therapy; Computed Tomography Angiography; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - mortality; Coronary Stenosis - physiopathology; Coronary Stenosis - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Female; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Multidetector Computed Tomography; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Revascularization; Predictive Value of Tests; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1876-861X

The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown. To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR ) and cardiovascular outcomes in patients with stable angina. Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR ≤ 0.80 were categorized as: Completely revascularized (CR-FFR ), all vessels with FFR ≤ 0.80 revascularized; incompletely revascularized (IR-FFR ), ≥ 1 vessels with FFR ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction. Amongst 900 patients and 1759 vessels, FFR was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR (15/210 [7.1%]) compared to CR-FFR (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p ​= ​0.036, and to normal FFR (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p ​ 0.80 (10/1223 [0.8%]), p ​ 0.80.