Abstract 17512: Stress Myocardial Perfusion Computed Tomography versus Fractional Flow Reserve for Guiding Percutaneous Coronary Intervention in Intermediate Coronary Artery Disease
Introduction: Percutaneous coronary intervention (PCI) based on invasively determined fractional flow reserve (FFR) has demonstrated improved event free survival. Stress myocardial computed tomography perfusion (CTP) permits the detection of haemodynamically relevant coronary artery disease (CAD) defined by FFR and has a potential to become a non-invasive test for replacing invasive FFR assessment. We sought to determine the clinical outcomes of stress CTP guided PCI compared with FFR-guided PCI.
Methods: We studied 206 patients (149 men, age 69 ± 10 years) who had angiographic luminal narrowing of 50-90% in the proximal or mid part of a major coronary artery. CT-guided PCI was performed in 88 patients and FFR-guided PCI in 118 patients. In FFR-guided group, FFR of less than 0.8 was considered significant and revascularization was indicated, while CT-guided PCI was guided by the ischemic territories identified on CT images in combination with the results of angiogram. Patients were followed up for the occurrence of cardiac events (cardiac death, nonfatal myocardial infarction, target vessel revascularization and stent thrombosis) at one year after the index procedure.
Results: Among 276 lesions in 206 consecutive patients, indication of PCI was based on CTP in 126 and FFR in 150 lesions, respectively. Baseline percent diameter stenosis was similar in both groups (62 ± 14 and 61 ± 17%, p=0.2). No significant difference was found in the percentage of lesions that underwent PCI (38.1% in CTP-guided group vs. 36.0% in FFR-guided group, P=0.7). A total of 10 cardiac events (one cardiac death, one myocardial infarction and 8 revascularizations) occurred. The one-year cardiac event rate for CTP-guided PCI (n=4) versus FFR-guided PCI (n=6) was 4.5% versus 5.1% (P=0.8).
Conclusion: CTP-guided PCI resulted in favorable outcomes without increasing revascularization rate as compared with FFR-guided PCI. The current results indicated that CTP-guided PCI will play an increasingly important role in selecting patients for revascularization versus medical therapy, and may be used as an alternative to invasive FFR-based approach.
Author Disclosures: S. Nakamori: None. K. Kitagawa: None. K. Dohi: None. M. Ishida: None. Y. Ichikawa: None. M. Nagata: None. T. Sawai: None. J. Masuda: None. N. Fujimoto: None. K. Onishi: None. M. Nakamura: None. H. Sakuma: None. M. Ito: None.
- © 2014 by American Heart Association, Inc.