Author + information
- Received June 20, 2018
- Revision received July 25, 2018
- Accepted July 30, 2018
- Published online September 7, 2018.
- Bjarne L. Nørgaard, MD, PhDa,∗ (, )@AUHdk,
- Christian J. Terkelsen, MD, PhDa,
- Ole N. Mathiassen, MD, PhDa,
- Erik L. Grove, MD, PhDa,
- Hans Erik Bøtker, MD, PhDa,
- Erik Parner, MSci, PhDb,
- Jonathon Leipsic, MDc,
- Flemming H. Steffensen, MD, PhDd,
- Anders H. Riis, MScie,
- Kamilla Pedersen, BSca,
- Evald H. Christiansen, MD, PhDa,
- Michael Mæng, MD, PhDa,
- Lars R. Krusell, MDa,
- Steen D. Kristensen, MD, PhDa,
- Ashkan Eftekhari, MD, PhDa,
- Lars Jakobsen, MD, PhDa and
- Jesper M. Jensen, MD, PhDa
- aDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- bDepartment of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
- cDepartment of Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- dDepartment of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark
- eDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- ↵∗Address for correspondence:
Dr. Bjarne L. Nørgaard, Department of Cardiology, Aarhus University Hospital, Palle-Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark.
Background Clinical outcomes following coronary computed tomography–derived fractional flow reserve (FFRCT) testing in clinical practice are unknown.
Objectives The study sought to assess real-world clinical outcomes following a diagnostic strategy including first-line coronary computed tomography angiography (CTA) with selective FFRCT testing.
Methods The study reviewed the results of 3,674 consecutive patients with stable chest pain evaluated with CTA and FFRCT testing to guide downstream management in patients with intermediate stenosis (30% to 70%). The composite endpoint (all-cause death, myocardial infarction, hospitalization for unstable angina, and unplanned revascularization) was determined in 4 patient groups: 1) CTA stenosis <30%, optimal medical treatment (OMT), and no additional testing; 2) FFRCT >0.80, OMT, no additional testing; 3) FFRCT ≤0.80, OMT, no additional testing; and 4) FFRCT ≤0.80, OMT, and referral to invasive coronary angiography. Patients were followed for a median of 24 (range: 8 to 41) months.
Results FFRCT was available in 677 patients, and the test result was negative (>0.80) in 410 (61%) patients. In 75% of the patients with FFRCT >0.80, maximum coronary stenosis was ≥50%. The cumulative incidence proportion (95% confidence interval [CI]) of the composite endpoint at the end of follow-up was comparable in groups 1 (2.8%; 95% CI: 1.4% to 4.9%) and 2 (3.9%; 95% CI: 2.0% to 6.9%) (p = 0.58) but was higher (when compared with group 1) in groups 3 (9.4%; p = 0.04) and 4 (6.6%; p = 0.08). Risk of myocardial infarction was lower in group 4 (1.3%) than in group 3 (8%; p < 0.001).
Conclusions In patients with intermediate-range coronary stenosis, FFRCT is effective in differentiating patients who do not require further diagnostic testing or intervention (FFRCT >0.80) from higher-risk patients (FFRCT ≤0.80) in whom further testing with invasive coronary angiography and possibly intervention may be needed. Further studies assessing the risk and optimal management strategy in patients undergoing first-line CTA with selective FFRCT testing are needed.
This work was financially supported by the Faculty of Health Sciences, Aarhus University Hospital. Dr. Nørgaard has received unrestricted research grants from Edwards Lifesciences, Siemens, and HeartFlow. Dr. Terkelsen has received research grant support from Terumo. Dr. Grove has received speaker honoraria or consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, MSD, Pfizer, and Roche. Dr. Leipsic has received speaker honoraria from GE Healthcare; served as a consultant for Edwards Lifesciences; and served as a consultant for and has stock options in Circle CVI and HeartFlow. Dr. Christiansen has received unrestricted research grants from St. Jude Medical. Dr. Bøtker has received unrestricted research grants from HeartFlow. Dr. Jensen has received speaker honoraria from Bracco Imaging. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 20, 2018.
- Revision received July 25, 2018.
- Accepted July 30, 2018.
- 2018 American College of Cardiology Foundation
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