Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

• Published in: Journal of cardiovascular computed tomography 2022-01, Vol.16 (1), p.19-26
• Main Authors: Takagi, Hidenobu, Leipsic, Jonathon A., McNamara, Noah, Martin, Isabella, Fairbairn, Timothy A., Akasaka, Takashi, Nørgaard, Bjarne L., Berman, Daniel S., Chinnaiyan, Kavitha, Hurwitz-Koweek, Lynne M., Pontone, Gianluca, Kawasaki, Tomohiro, Rønnow Sand, Niels Peter, Jensen, Jesper M., Amano, Tetsuya, Poon, Michael, Øvrehus, Kristian A., Sonck, Jeroen, Rabbat, Mark G., Mullen, Sarah, De Bruyne, Bernard, Rogers, Campbell, Matsuo, Hitoshi, Bax, Jeroen J., Douglas, Pamela S., Patel, Manesh R., Nieman, Koen, Ihdayhid, Abdul Rahman
• Format: Article
• Language: English
• Subjects: Computed Tomography Angiography; Coronary Angiography; Coronary artery disease (CAD); Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary computed tomography angiography (CCTA); Coronary Stenosis - diagnostic imaging; Coronary Stenosis - therapy; Coronary Vessels - diagnostic imaging; Female; Fractional flow reserve (FFR); Fractional flow reserve derived from coronary computed tomography (FFRCT); Fractional Flow Reserve, Myocardial; Humans; Male; Predictive Value of Tests; Registries; Severity of Illness Index; Tomography, X-Ray Computed
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2021.08.003

The role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown. To investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization. Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 ​cm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis. Of 4730 patients (66 ​± ​10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase [95% confidence interval], 1.31 [1.26–1.35]; p ​