Abstract 18978: Fractional Flow Reserve Derived From Coronary Computed Tomography Safely Defers Invasive Coronary Angiography in Patients With Stable Coronary Artery Disease
Introduction: Fractional flow reserve (FFR) derived from coronary computed tomography datasets (FFRCT) has excellent accuracy to diagnose hemodynamically significant coronary artery disease (CAD) compared to invasive FFR as the reference standard. The recent PLATFORM Trial demonstrated that the use of FFRCT resulted in the safe cancellation of 61% of invasive coronary angiograms (ICA). In the United States, the real world feasibility of a diagnostic strategy using FFRCT is unknown. Thus, we sought to determine whether the use of a coronary computed tomography angiogram (CT) plus FFRCT guided strategy as compared to CT alone will reduce the rate of unnecessary ICA without increasing the occurrence of major cardiac events.
Hypothesis: A combined CT/FFRCT guided diagnostic strategy will safely reduce the number of ICA compared to CT alone.
Methods: 138 consecutive patients with suspected CAD referred for CT / FFRCT over a 9-month period without known CAD at Loyola University Chicago were included in the analysis. Intermediate lesions 30-90% diameter of stenosis were considered for our analysis. FFR ≤0.80 in a vessel of diameter > 1.8mm was considered diagnostic of lesion-specific ischemia and functionally significant. Rates of patients having ICA, revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and major adverse cardiac events defined by death, myocardial infarction or urgent revascularization were recorded.
Results: 138 patients were treated using CT/ FFRCT strategy. 57 of 138 patients had intermediate CAD by CT. FFRCT results were available in 42 of 57 (74%) patients with intermediate CAD. 14 of 42 patients had at least 1 vessel with FFRCT ≤0.80. 12 of 57 patients underwent ICA and 9 were revascularized (7 PCI, 2 CABG). A CT only guided strategy would have resulted in 57 ICAs. FFRCT reduced the number of unnecessary ICA by 79% (45 of 57). Using the CT/ FFRCT strategy the proportion of ICA patients who were revascularized was 75% (9 of 12). There were no adverse events in mean follow-up interval of 104 days.
Conclusion: CT/ FFRCT safely deferred ICA in patients with intermediate CAD. A high proportion of those who underwent ICA were revascularized resulting in efficient use of catheterization lab resources.
Author Disclosures: M.G. Rabbat: None. B. Kauh: None. B. Forrest: Employment; Significant; Employment. S. Sengupta: Employment; Significant; Employment. C. Rogers: Employment; Significant; Employment. K. Dajani: None. A. Goldberg: None. D. Wilber: None. J. Lopez: None.
- © 2016 by American Heart Association, Inc.