Abstract 15042: The First Clinical Use of Fractional Flow Reserve Derived From Coronary CT Angiography (FFR-CT) in the ‘Real World’ Predicts Standard of Care Guided Revascularization
Introduction: Fractional flow reserve computed tomography (FFR-CT), approved by the FDA in November 2014, provides functional assessment of anatomic severity and blood flow in the coronary arteries without changes in acquisition, medication, contrast or radiation, with an area under the receiver-operating characteristic curve of 0.90 compared to invasive FFR. We obtained FFR-CT in the largest group of patients in the United States post-FDA release and applied this measure to patients who had previously undergone invasive coronary angiography after baseline Coronary CTA.
Hypothesis: To determine whether FFR-CT predicts subsequent coronary revascularization in patients who underwent Coronary CTA prior to invasive angiography and were treated with standard of care in a large urban Cardiology practice.
Methods: Consecutive patients who underwent Coronary CTA followed by invasive angiography over a 12-month period from 2012-2013 were identified. Studies that did not fit inclusion criteria (e.g. prior revascularization, motion artifact, severe calcification) were excluded. The remaining studies (n=61) were sent for FFR-CT analysis and patients who received stents (n=15) were identified. FFR-CT values were compared in territories that were stented (n=15) with those that were not (n=163). Baseline FFR-CT values were obtained retrospectively, and therefore results did not interfere with clinical decision-making.
Results: In territories that were not intervened upon, baseline FFR-CT values had a median of 0.87, with 75% of territories displaying an FFR-CT > 0.80. In territories that underwent PCI, baseline FFR-CT values were all < 0.75, with a median of 0.65 (P<0.0001 PCI vs. no stent). Of 18 patients with an FFR-CT < 0.70; 11 underwent PCI, 2 had chronic total occlusions and the remaining 5 pursued aggressive medical management based on clinical judgment.
Conclusions: We established baseline FFR-CT values in patients who underwent PCI in the real world outside of a research protocol. The role of FFR-CT in clinical decision-making and to determine the need for revascularization requires prospective trials; however FFR-CT determined prior to invasive coronary angiography accurately predicts subsequent revascularization in clinical practice.
Author Disclosures: R.R. Packard: None. R. Nakanishi: None. A. Lajoie: None. M.J. Buddoff: None. R.P. Karlsberg: None.
- © 2015 by American Heart Association, Inc.