Computed tomography (CT)–derived fractional flow reserve (FFRCT) is effective in differentiating patients with intermediate range coronary stenosis who do not require further diagnostic testing or intervention (FFRCT >0.80) from those who may require further testing with invasive coronary angiography and possibly intervention (FFRCT ≤0.80), based on findings presented Aug. 25 at ESC Congress 2018 and simultaneously published in the Journal of the American College of Cardiology.

Researchers reviewed the results of 3,674 consecutive patients who had been evaluated using CTA and FFRCT testing to guide downstream management of those with intermediate stenosis. The primary endpoint was all-cause death, myocardial infarction (MI), hospitalization for unstable angina, and unplanned revascularization in the following four patient groups: 1) CTA Stenosis <30 percent, optimal medical treatment (OMT) and no additional testing; 2) FFRCT >0.80, OMT, and no additional testing; 3) FFRCT ≤0.80, OMT, and no additional testing; and 4) FFRCT ≤0.80 OMT, and referral to invasive coronary angiography.

According to study investigators, their findings showed "the presence of intermediate range coronary artery disease (CAD) and FFRCT >0.80 was associated with favorable clinical outcomes similar to the prognosis in patients without or with minimal evidence of CAD who had no planned downstream testing." Specifically, in 75 percent of the 410 patients with FFRCT >0.80, maximum coronary stenosis was ≥50 percent. The primary endpoint was comparable in the first (2.8 percent) and second (3.9 percent) patient groups, but was higher in groups three and four (when compared to group one). However, researchers noted that "risk of an unfavorable outcome was increased (driven by a higher incidence of nonfatal MI) in patients with a positive FFRCT result who were not referred to invasive coronary angiography."

"The findings in this study are of significant clinical relevance to provide further insight as to how FFRCT may be used to help avoid unnecessary [invasive coronary angiography] testing following the identification of moderate CAD," researchers said. "Future studies are needed to further assess the risk and optimal management strategy in patients undergoing first-line coronary CTA with selective FFRCT testing."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging, Chronic Angina

Keywords: ESC18, ESC Congress, Angina, Stable, Coronary Artery Disease, Tomography, X-Ray Computed, Angiography, Coronary Angiography, Arteries

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