FFRCT in Nonculprit Lesions of Patients With Recent STEMI

Oct 19, 2016
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Authors:
Gaur S, Taylor CA, Jensen JM, et al.
Citation:
FFR Derived From Coronary CT Angiography in Nonculprit Lesions of Patients With Recent STEMI. JACC Cardiovasc Imaging 2016;Oct 12:[Epub ahead of print].
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

What is the accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) to diagnose ischemia of nonculprit vessels in patients with recent ST-segment elevation myocardial infarction (STEMI)?

Methods:

This study evaluated the diagnostic accuracy of FFR-CT in 124 nonculprit vessels among 60 patients with recent STEMI and multivessel coronary artery disease. Invasive angiography and FFR, and CCTA and FFRCT were performed 1 month following STEMI. The accuracy of FFRCT, CCTA alone, and invasive angiography was compared with invasive FFR. For comparison of coronary volume-to-left ventricular mass ratio, the study population was compared with a matched cohort from a prior study of FFRCT in patients with stable angina.

Results:

In comparison with invasive FFR, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 64%, 93%, 49%, 48%, and 93% for CCTA alone; 72%, 76%, 70%, 56%, and 85% for invasive angiography alone; and 72%, 83%, 66%, 56%, and 89% for FFRCT, respectively. The overall accuracy of FFRCT was higher than CCTA alone (p = 0.03), but not different from invasive angiography (p = 1.0). Median coronary volume-to-left ventricular mass ratio was decreased in patients with recent STEMI in comparison to a matched cohort with stable angina (53 vs. 65 mm3/g, p = 0.009).

Conclusions:

The diagnostic accuracy of FFRCT is not superior to invasive angiography for identification of ischemia by invasive FFR in nonculprit coronary arteries following STEMI.

Perspective:

While FFRCT is a promising approach that may improve our ability to identify vessel-specific ischemia over CCTA alone in patients with stable angina, this study suggests that FFRCT has limited accuracy in patients with a recent STEMI. The overall accuracy of FFRCT to identify coronary arteries with ischemia was identical to that reported with invasive angiography. This contrasts with prior literature demonstrating an improved accuracy of FFRCT over either CCTA or invasive angiography in comparison to invasive FFR. The authors found that patients after STEMI had smaller coronary volume-to-left ventricular mass ratios in comparison to a matched cohort from an earlier study, which suggests a possible explanation for this difference. The data from this small single-center study suggest that FFRCT does not have a current role in patients with recent STEMI.

Keywords: Acute Coronary Syndrome, Angina, Stable, Coronary Angiography, Coronary Artery Disease, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Ischemia, Myocardial Infarction, Tomography, X-Ray Computed


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