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Incremental value of on-site computed tomography-derived fractional flow reserve for the diagnosis and management strategy of obstructive coronary artery disease in the randomized CRESCENT trials

Session Poster Session 7

Speaker Fay Nous

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : CT-derived FFR
  • Session type : Poster Session

Authors : F Nous (Rotterdam,NL), R Budde (Rotterdam,NL), M Lubbers (Rotterdam,NL), Y Yamasaki (Fukuoka,JP), P Musters (Rotterdam,NL), T Bruning (Rotterdam,NL), J Akkerhuis (Rotterdam,NL), M Kofflard (Dordrecht,NL), B Kietselaer (Maastricht,NL), T Galema (Rotterdam,NL), K Nieman (Palo Alto,US)

Authors:
F Nous1 , R Budde1 , M Lubbers1 , Y Yamasaki2 , P Musters1 , T Bruning3 , J Akkerhuis4 , M Kofflard5 , B Kietselaer6 , T Galema1 , K Nieman7 , 1Erasmus University Medical Centre - Rotterdam - Netherlands (The) , 2Kyushu University - Fukuoka - Japan , 3Maasstad Ziekenhuis - Rotterdam - Netherlands (The) , 4Sint Franciscus Gasthuis - Rotterdam - Netherlands (The) , 5Albert Schweitzer Hospital - Dordrecht - Netherlands (The) , 6Maastricht University Medical Centre (MUMC) - Maastricht - Netherlands (The) , 7Stanford University - Palo Alto - United States of America ,

Citation:

Background: Coronary computed tomography angiography (CCTA) accurately rules out coronary artery disease (CAD), but has a limited ability to predict hemodynamically significant CAD. Implementing on-site computed tomography-derived fractional flow reserve (CT-FFR) could improve the clinical value and efficiency of cardiac CT in the diagnostic work-up of patients with stable angina.

Purpose: To determine the impact of on-site CT-FFR on diagnostic effectiveness, management strategy and downstream invasive coronary angiography (ICA) in patients with suspected CAD.

Methods: 196 patients (59.1 ± 9.6 years, 47% women) with suspected CAD underwent a CCTA in the CRESCENT I and II trials. On-site CT-FFR analysis was performed in all patients with at least one =50% stenosis on CCTA (N=53). We assessed the effect of adding CT-FFR analysis to CCTA in terms of 1) diagnostic effectiveness, i.e. the number of additional tests required to determine the final diagnosis; 2) reclassification of the initial management strategy; 3) ICA efficiency, i.e. ICA rate without =50% CAD.

Results: CT-FFR was calculated in 42/53 (79%) of the eligible patients as it could not be calculated in patients with suspected coronary total occlusion (N=7), severe coronary calcification (N=2), severe CT artefacts (N=1) or missing CT images (N=1). CT-FFR =0.80 was present in 27/196 (14%) patients, including 8/196 (4%) patients with high-risk ischemia (CT-FFR =0.80 in all three vessels, left main or proximal left anterior descending coronary artery). The final diagnosis was achieved with CT-FFR in an additional 30/196 (15%) patients compared to CT alone (p<0.0001), and rendered 42/56 (75%) of additional tests unnecessary (p<0.0001). The initial management strategy was reclassified in 30/196 patients (15%, p<0.0001); 24/196 (12%) patients were reclassified to optimal medical therapy and 6/196 (3%) patients were reclassified directly to ICA including 4/8 (50%) patients with high-risk CAD on ICA. CT-FFR would result in 6/32 (19%, p=0.012) ICA cancellations in which none of the patients had high-risk CAD. The rate of ICA without =50% stenosis would decrease from 22% (7/32) to 11% (3/27) (p=0.012).

Conclusion: Implementation of CT-FFR has the potential for improved diagnostic effectiveness. Functional reclassification of CAD provides more efficient ICA referral in patients with suspected CAD compared to CTA alone.

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