Highlights
- •The gold standard method to assess the functional impact of coronary artery disease (CAD) is invasive coronary angiography (ICA)
- •Non-invasive fractional flow reserve computed tomography (FFRct) identifies hemodynamically significant CAD
- •FFRct has a high sensitivity and specificity for predicting functional CAD among patients with abnormal SPECT studies relative to ICA
- •Addition of FFRct was safe and did not increase risk of MACE or mortality in a real-world setting
- •FFRct usage could potentially reduce the rate of unnecessary invasive imaging in intermediate-high risk patients with suspected CAD
Abstract
Background
Fractional flow reserve computed tomography (FFRct) allows for non-invasive assessment
of hemodynamically significant coronary artery disease (CAD). Real-world data regarding
the diagnostic performance of FFRct is scarce. We aim to validate the diagnostic performance
of FFRct against invasive coronary angiography (ICA) in patients with stable angina
and an abnormal single photon emission computed tomography (SPECT) study.
Methods
This prospective, single-cohort, real-world study enrolled consecutive adult patients
with stable angina and an abnormal SPECT study who were referred for ICA. Prior to
ICA, FFRct analysis was performed. Sensitivity and specificity of FFRct were evaluated
at the patient and vessel level against ICA. Physician intuition-based diagnosis of
hemodynamically significant CAD was also documented prior to ICA.
Results
A total of 66 patients were enrolled; 10 were excluded due to protocol deviation or
missing studies. FFRct achieved 95% sensitivity and 83% specificity at the patient
level, and 78% sensitivity and 88% specificity at the vessel level. FFRct was most
accurate in the left circumflex artery (sensitivity 83%, specificity 92%) and the
least in the left anterior descending artery (80% sensitivity, 78% specificity). FFRct
identified hemodynamically significant CAD more accurately than physician intuition
(sensitivity 95% vs 84%; specificity 83% vs 46%). If physicians had been unblinded
to FFRct, ICA may have been avoided in up to 53% of patients.
Conclusion
We performed a real-world study to validate the diagnostic performance of FFRct against
gold-standard invasive imaging. FFRct has high sensitivity and specificity for the
diagnosis of hemodynamically significant CAD in intermediate-to-high risk patients.
Keywords
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Article info
Publication history
Published online: August 12, 2022
Accepted:
August 9,
2022
Received in revised form:
August 8,
2022
Received:
May 17,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
