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Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.

Publication ,  Journal Article
Nørgaard, BL; Gaur, S; Fairbairn, TA; Douglas, PS; Jensen, JM; Patel, MR; Ihdayhid, AR; Ko, BSH; Sellers, SL; Weir-McCall, J; Matsuo, H ...
Published in: Heart
February 2022

OBJECTIVES: To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). METHODS: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. RESULTS: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). CONCLUSIONS: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

February 2022

Volume

108

Issue

3

Start / End Page

194 / 202

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Infarction
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Vessels
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
 

Citation

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Nørgaard, B. L., Gaur, S., Fairbairn, T. A., Douglas, P. S., Jensen, J. M., Patel, M. R., … Abdulla, J. (2022). Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis. Heart, 108(3), 194–202. https://doi.org/10.1136/heartjnl-2021-319773
Nørgaard, Bjarne L., Sara Gaur, Timothy A. Fairbairn, Pam S. Douglas, Jesper M. Jensen, Manesh R. Patel, Abdul R. Ihdayhid, et al. “Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.Heart 108, no. 3 (February 2022): 194–202. https://doi.org/10.1136/heartjnl-2021-319773.
Nørgaard BL, Gaur S, Fairbairn TA, Douglas PS, Jensen JM, Patel MR, et al. Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis. Heart. 2022 Feb;108(3):194–202.
Nørgaard, Bjarne L., et al. “Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.Heart, vol. 108, no. 3, Feb. 2022, pp. 194–202. Pubmed, doi:10.1136/heartjnl-2021-319773.
Nørgaard BL, Gaur S, Fairbairn TA, Douglas PS, Jensen JM, Patel MR, Ihdayhid AR, Ko BSH, Sellers SL, Weir-McCall J, Matsuo H, Sand NPR, Øvrehus KA, Rogers C, Mullen S, Nieman K, Parner E, Leipsic J, Abdulla J. Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis. Heart. 2022 Feb;108(3):194–202.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

February 2022

Volume

108

Issue

3

Start / End Page

194 / 202

Location

England

Related Subject Headings

  • Tomography, X-Ray Computed
  • Prognosis
  • Predictive Value of Tests
  • Myocardial Infarction
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Vessels
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography