Author + information
- Amir Ali Ahmadia,b,
- Jonathan Leipsica,b,
- Kristian Ovrehusa,b,
- Sara Gaura,b,
- Angel Sanz Salvoa,b,
- Gina LaRoccaa,b,
- Pedro Morenoa,b,
- Bjarne Norgaarda,b and
- Jagat Narulaa,b
Background: The FAME and FAME 2 studies demonstrated that while lesions with normal FFR (FFR-) have near perfect negative predictive value (NPV) for future myocardial infarction (MI), only a small portion of the ischemic (FFR+) lesions result in death/MI if treated with medical therapy alone. Numerous studies have shown that abscence of obstructive lesions with high risk features also have excellent NPV for coronary events. Recently, it has been shown that CT-verified low attenuation plaque (LAP) – surrogate for the necrotic core – is predictive of FFR. The aim of this study is to determine if FFR indirectly screens for obstructive lesions with moderate to large necrotic core.
Methods: In a prospective, multicenter study of 254 patients (64±10 years, 64% male), coronary CT angiography (CCTA), invasive angiography (ICA) and invasive FFR were evaluated for 384 lesions. Ischemia was defined by invasive FFR ≤0.80. Stenotic plaques were defined as >50% luminal stenosis by ICA measurement. Quantification of LAP volume (<30 HU), was assessed by semi-automated software (AutoPlaq) from standard CCTA images. Distribution of various types of plaques with regards to stenosis and LAP morphology were examined amongst the FFR- and FFR+ lesions.
Results: Total of 301 FFR- lesions and 83 FFR+ lesions were identified. Amongst FFR-lesions, 53% were non-stenotic with small LAP volume, while only 6% were stenotic with moderate or large LAP volume. Amongst FFR+ plaques, while 30% were obstructive with moderate or large LAP, 28% had small LAP and 44% were non obstructive.
Conclusions: FFR may be a sensitive but not a specific detector of obstructive lesions with high risk features. The distribution of various plaque types amongst FFR- and FFR+ lesions may explain the outcomes associated with FFR guided therapy.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-336
- 2017 American College of Cardiology Foundation