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Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial.

Publication ,  Journal Article
Lu, MT; Ferencik, M; Roberts, RS; Lee, KL; Ivanov, A; Adami, E; Mark, DB; Jaffer, FA; Leipsic, JA; Douglas, PS; Hoffmann, U
Published in: JACC Cardiovasc Imaging
November 2017

OBJECTIVES: The purpose of this study was to determine whether noninvasive fractional flow reserve derived from computed tomography (FFRCT) predicts coronary revascularization and outcomes and whether its addition improves efficiency of referral to invasive coronary angiography (ICA) after coronary computed tomography angiography (CTA). BACKGROUND: FFRCT may improve the efficiency of an anatomic CTA strategy for stable chest pain. METHODS: This observational cohort study included patients with stable chest pain in the PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) trial referred to ICA within 90 days after CTA. FFRCT was measured at a blinded core laboratory, and FFRCT results were unavailable to caregivers. We determined the agreement of FFRCT (positive if ≤0.80) with stenosis on CTA and ICA (positive if ≥50% left main or ≥70% other coronary artery), and predictive value for a composite of coronary revascularization or major adverse cardiac events (death, myocardial infarction, or unstable angina). We retrospectively assessed whether adding FFRCT ≤0.80 as a gatekeeper could improve efficiency of referral to ICA, defined as decreased rate of ICA without ≥50% stenosis and increased ICA leading to revascularization. RESULTS: FFRCT was calculated in 67% (181 of 271) of eligible patients (mean age 62 years; 36% women). FFRCT was discordant with stenosis in 31% (57 of 181) for CTA and 29% (52 of 181) for ICA. Most patients undergoing coronary revascularization had an FFRCT of ≤0.80 (91%; 80 of 88). An FFRCT of ≤0.80 was a significantly better predictor for revascularization or major adverse cardiac events than severe CTA stenosis (HR: 4.3 [95% confidence interval [CI]: 2.4 to 8.9] vs. 2.9 [95% CI: 1.8 to 5.1]; p = 0.033). Reserving ICA for patients with an FFRCT of ≤0.80 could decrease ICA without ≥50% stenosis by 44%, and increase the proportion of ICA leading to revascularization by 24%. CONCLUSIONS: In this hypothesis-generating study of patients with stable chest pain referred to ICA from CTA, an FFRCT of ≤0.80 was a better predictor of revascularization or major adverse cardiac events than severe stenosis on CTA. Adding FFRCT may improve efficiency of referral to ICA from CTA alone.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

November 2017

Volume

10

Issue

11

Start / End Page

1350 / 1358

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Radiographic Image Interpretation, Computer-Assisted
  • Predictive Value of Tests
  • Myocardial Revascularization
  • Multidetector Computed Tomography
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Lu, M. T., Ferencik, M., Roberts, R. S., Lee, K. L., Ivanov, A., Adami, E., … Hoffmann, U. (2017). Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial. JACC Cardiovasc Imaging, 10(11), 1350–1358. https://doi.org/10.1016/j.jcmg.2016.11.024
Lu, Michael T., Maros Ferencik, Rhonda S. Roberts, Kerry L. Lee, Alexander Ivanov, Elizabeth Adami, Daniel B. Mark, et al. “Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial.JACC Cardiovasc Imaging 10, no. 11 (November 2017): 1350–58. https://doi.org/10.1016/j.jcmg.2016.11.024.
Lu MT, Ferencik M, Roberts RS, Lee KL, Ivanov A, Adami E, et al. Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial. JACC Cardiovasc Imaging. 2017 Nov;10(11):1350–8.
Lu, Michael T., et al. “Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial.JACC Cardiovasc Imaging, vol. 10, no. 11, Nov. 2017, pp. 1350–58. Pubmed, doi:10.1016/j.jcmg.2016.11.024.
Lu MT, Ferencik M, Roberts RS, Lee KL, Ivanov A, Adami E, Mark DB, Jaffer FA, Leipsic JA, Douglas PS, Hoffmann U. Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial. JACC Cardiovasc Imaging. 2017 Nov;10(11):1350–1358.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

November 2017

Volume

10

Issue

11

Start / End Page

1350 / 1358

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Severity of Illness Index
  • Retrospective Studies
  • Randomized Controlled Trials as Topic
  • Radiographic Image Interpretation, Computer-Assisted
  • Predictive Value of Tests
  • Myocardial Revascularization
  • Multidetector Computed Tomography
  • Middle Aged
  • Male