DeFACTO: Improved Diagnostic Accuracy With Fractional Flow Reserve Plus CT

Use of non-invasive fractional flow reserve plus coronary computed tomographic (FFRCT) angiography in stable patients with suspected or known coronary artery disease (CAD) can improve diagnostic accuracy and discrimination compared to CT alone, according to the DeFACTO study, published on Aug. 26 in The Journal of the American Medical Association and simultaneously presented at ESC Congress 2012 in Munich.


Overall, the study found that on a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of FFRCT were 73 percent, 90 percent, 54 percent, 67 percent and 84 percent, respectively. When compared with obstructive CAD diagnosed by CT alone (area under the receiver operating characteristic curve [AUC], 0.68; 95 percent CI, 0.62-0.74), FFRCT was "associated with improved discrimination" (AUC, 0.81; 95 percent CI, 0.75-0.86; P<.001).

While the study did not achieve its primary outcome goal for the level of per-patient diagnostic accuracy, the study authors note that the results still suggest the potential of FFRCT as a promising non-invasive method for identification of individuals with ischemia. The multicenter diagnostic performance study was the first "large-scale prospective demonstration of the use of computational models to calculate rest and hyperemic coronary pressure fields from typically acquired CT images."


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