J Cardiovasc Comput Tomogr. 2024;18(3):251-258.
Long-term prognostic implications of CT angiography-derived fractional flow reserve: Results from the DISCOVER-FLOW study.
제1저자 양석훈, 정재욱 · 교신저자 구본권
소속 (7)
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia.
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
- The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
BACKGROUND & OBJECTIVES The long-term prognostic implications of CT angiography-derived fractional flow reserve (FFRCT) remains unclear. We aimed to explore the long-term outcomes of FFRCT in the first-in-human study of it.
MATERIALS & METHODS A total of 156 vessels from 102 patients with stable coronary artery disease, who underwent coronary CT angiography (CCTA) and invasive FFR measurement, were followed. The primary endpoint was target vessel failure (TVF), including cardiovascular death, target vessel myocardial infarction, and target vessel revascularization. Outcome analysis with FFRCT was performed on a per-vessel basis using a marginal Cox proportional hazard model.
RESULTS During median 9.9 years of follow-up, TVF occurred in 20 (12.8%) vessels. FFRCT ≤0.80 discriminated TVF (hazard ratio [HR] 2.61, 95% confidence interval [CI] 1.06, 6.45). Among 94 vessels with deferral of percutaneous coronary intervention (PCI), TVF risk was inversely correlated with FFRCT (HR 0.62 per 0.1 increase, 95% CI 0.44, 0.86), with the cumulative incidence of TVF being 2.6%, 15.2%, and 28.6% for vessels with FFRCT >0.90, 0.81-0.90, and ≤0.80, respectively (p-for-trend 0.005). Predictive value for clinical outcomes of FFRCT was similar to that of invasive FFR (c-index 0.79 vs 0.71, P = 0.28). The estimated TVF risk was higher in the deferral of PCI group than the PCI group for vessels with FFRCT ≤0.81.
CONCLUSION FFRCT showed improved long-term risk stratification and displayed a risk continuum similar to invasive FFR.
CLINICAL TRIAL REGISTRATION NCT01189331.
Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
Keywords
Coronary CT angiographyFractional flow reserveLong-term outcomeNon-invasive imagingRisk stratification
Conflict of interest statement
Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interest: BKK received research grants from Abbott, Philips, and HeartFlow, provided to the Seoul National University. JL holds stock options in and serves as a consultant to HeartFlow and Circle CVI, and has a research grant from GE Healthcare. GC, MS, CZ, and CAT are the employees and shareholders of HeartFlow, Inc.
그 밖의 정보
- 출판 형태
- Clinical Trial, Journal Article, Multicenter Study
- 저널
- Journal of cardiovascular computed tomography · eISSN 1876-861X
- 전자 출판
- 2024-02-19
- MeSH
- Aged · Female · Humans · Male · Middle Aged · Computed Tomography Angiography* · Coronary Angiography* · Coronary Artery Disease* / diagnostic imaging / physiopathology / mortality / therapy · Coronary Vessels / diagnostic imaging / physiopathology · Fractional Flow Reserve, Myocardial* · Multidetector Computed Tomography · Percutaneous Coronary Intervention · Predictive Value of Tests* · Prognosis · Prospective Studies · Risk Assessment · Risk Factors · Time Factors
- 데이터
- ClinicalTrials.gov: NCT01189331