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

• Published in: European radiology 2023-08, Vol.33 (8), p.5465-5475
• Main Authors: Becker, Leonie M., Peper, Joyce, Verhappen, Bram J. L. A., Swart, Laurens A., Dedic, Admir, van Dockum, Willem G., van der Ent, Martin, Royaards, Kees-Jan, Niezen, André, Hensen, Jan-Hein J., van Kuijk, Jan-Peter, Mohamed Hoesein, Firdaus A. A., Leiner, Tim, Bruning, Tobias A., Swaans, Martin J.
• Format: Article
• Language: English
• Subjects: Angiography; Cardiac; Cardiovascular disease; Clinical Decision-Making; Complications; Computed tomography; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary Stenosis - diagnosis; Coronary vessels; Decision making; Diagnostic Radiology; Diagnostic systems; Diagnostic tests; Fractional Flow Reserve, Myocardial; Heart diseases; Heart rate; Humans; Imaging; Internal Medicine; Interventional Radiology; Management decisions; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Patient satisfaction; Patients; Positron emission; Predictive Value of Tests; Prognosis; Radiology; Reduction; Retrospective Studies; Single photon emission computed tomography; Tomography; Tomography, X-Ray Computed; Ultrasound; Vein & artery diseases
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-023-09517-z

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