Incidence and predictors of lesion-specific ischemia by FFRCT

Learnings from the international ADVANCE registry

Hironori Kitabata, Jonathon Leipsic*, Manesh R. Patel, Koen Nieman, Bernard De Bruyne, Campbell Rogers, Gianluca Pontone, Bjarne L. Nørgaard, Jeroen J. Bax, Gilbert Raff, Kavitha M. Chinnaiyan, Mark Rabbat, Niels Peter Rønnow Sand, Philipp Blanke, Timothy A. Fairbairn, Hitoshi Matsuo, Tetsuya Amano, Tomohiro Kawasaki, Yoshihiro Morino, Takashi Akasaka

*Kontaktforfatter for dette arbejde

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Resumé

BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.

METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFR CT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFR CT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR CT.

RESULTS: FFR CT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFR CT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR CT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFR CT. In addition, >70% stenosis was significantly associated with low FFR CT (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001).

CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR CT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.

OriginalsprogEngelsk
TidsskriftJournal of Cardiovascular Computed Tomography
Vol/bind12
Udgave nummer2
Sider (fra-til)95-100
ISSN1934-5925
DOI
StatusUdgivet - 10. feb. 2018

Fingeraftryk

Registries
Pathologic Constriction
Incidence
Odds Ratio
Confidence Intervals
Multivariate Analysis
Coronary Artery Disease
Computed Tomography Angiography

Citer dette

Kitabata, Hironori ; Leipsic, Jonathon ; Patel, Manesh R. ; Nieman, Koen ; De Bruyne, Bernard ; Rogers, Campbell ; Pontone, Gianluca ; Nørgaard, Bjarne L. ; Bax, Jeroen J. ; Raff, Gilbert ; Chinnaiyan, Kavitha M. ; Rabbat, Mark ; Rønnow Sand, Niels Peter ; Blanke, Philipp ; Fairbairn, Timothy A. ; Matsuo, Hitoshi ; Amano, Tetsuya ; Kawasaki, Tomohiro ; Morino, Yoshihiro ; Akasaka, Takashi. / Incidence and predictors of lesion-specific ischemia by FFRCT : Learnings from the international ADVANCE registry. I: Journal of Cardiovascular Computed Tomography. 2018 ; Bind 12, Nr. 2. s. 95-100.
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title = "Incidence and predictors of lesion-specific ischemia by FFRCT: Learnings from the international ADVANCE registry",
abstract = "BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFR CT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFR CT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR CT. RESULTS: FFR CT data were analyzed in 952 patients (95.2{\%}). Overall, 51.1{\%} patients had a positive FFR CT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR CT than those with <3 risk factors (60.2{\%} vs. 43.9{\%}, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95{\%} confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95{\%}CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFR CT. In addition, >70{\%} stenosis was significantly associated with low FFR CT (OR 31.16, 95{\%}CI 12.25-79.22, p < 0.0001) vs. <30{\%} stenosis. Notably, stenosis 30-49{\%} vs. <30{\%} had an increased likelihood of ischemia (OR 3.74, 95{\%}CI 1.52-9.17, p < 0.0001). CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR CT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.",
keywords = "Coronary artery disease, FFR, Ischemia, Multivariate Analysis, Predictive Value of Tests, Prospective Studies, Humans, Middle Aged, Male, Incidence, Coronary Stenosis/diagnostic imaging, Europe/epidemiology, Asia/epidemiology, Female, Registries, Odds Ratio, Coronary Angiography/methods, North America/epidemiology, Severity of Illness Index, Multidetector Computed Tomography, Reproducibility of Results, Risk Factors, Logistic Models, Chi-Square Distribution, Computed Tomography Angiography, Coronary Artery Disease/diagnostic imaging, Fractional Flow Reserve, Myocardial, Aged, Coronary Vessels/diagnostic imaging",
author = "Hironori Kitabata and Jonathon Leipsic and Patel, {Manesh R.} and Koen Nieman and {De Bruyne}, Bernard and Campbell Rogers and Gianluca Pontone and N{\o}rgaard, {Bjarne L.} and Bax, {Jeroen J.} and Gilbert Raff and Chinnaiyan, {Kavitha M.} and Mark Rabbat and {R{\o}nnow Sand}, {Niels Peter} and Philipp Blanke and Fairbairn, {Timothy A.} and Hitoshi Matsuo and Tetsuya Amano and Tomohiro Kawasaki and Yoshihiro Morino and Takashi Akasaka",
year = "2018",
month = "2",
day = "10",
doi = "10.1016/j.jcct.2018.01.008",
language = "English",
volume = "12",
pages = "95--100",
journal = "Journal of Cardiovascular Computed Tomography",
issn = "1934-5925",
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Kitabata, H, Leipsic, J, Patel, MR, Nieman, K, De Bruyne, B, Rogers, C, Pontone, G, Nørgaard, BL, Bax, JJ, Raff, G, Chinnaiyan, KM, Rabbat, M, Rønnow Sand, NP, Blanke, P, Fairbairn, TA, Matsuo, H, Amano, T, Kawasaki, T, Morino, Y & Akasaka, T 2018, 'Incidence and predictors of lesion-specific ischemia by FFRCT: Learnings from the international ADVANCE registry', Journal of Cardiovascular Computed Tomography, bind 12, nr. 2, s. 95-100. https://doi.org/10.1016/j.jcct.2018.01.008

Incidence and predictors of lesion-specific ischemia by FFRCT : Learnings from the international ADVANCE registry. / Kitabata, Hironori; Leipsic, Jonathon; Patel, Manesh R.; Nieman, Koen; De Bruyne, Bernard; Rogers, Campbell; Pontone, Gianluca; Nørgaard, Bjarne L.; Bax, Jeroen J.; Raff, Gilbert; Chinnaiyan, Kavitha M.; Rabbat, Mark; Rønnow Sand, Niels Peter; Blanke, Philipp; Fairbairn, Timothy A.; Matsuo, Hitoshi; Amano, Tetsuya; Kawasaki, Tomohiro; Morino, Yoshihiro; Akasaka, Takashi.

I: Journal of Cardiovascular Computed Tomography, Bind 12, Nr. 2, 10.02.2018, s. 95-100.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Incidence and predictors of lesion-specific ischemia by FFRCT

T2 - Learnings from the international ADVANCE registry

AU - Kitabata, Hironori

AU - Leipsic, Jonathon

AU - Patel, Manesh R.

AU - Nieman, Koen

AU - De Bruyne, Bernard

AU - Rogers, Campbell

AU - Pontone, Gianluca

AU - Nørgaard, Bjarne L.

AU - Bax, Jeroen J.

AU - Raff, Gilbert

AU - Chinnaiyan, Kavitha M.

AU - Rabbat, Mark

AU - Rønnow Sand, Niels Peter

AU - Blanke, Philipp

AU - Fairbairn, Timothy A.

AU - Matsuo, Hitoshi

AU - Amano, Tetsuya

AU - Kawasaki, Tomohiro

AU - Morino, Yoshihiro

AU - Akasaka, Takashi

PY - 2018/2/10

Y1 - 2018/2/10

N2 - BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFR CT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFR CT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR CT. RESULTS: FFR CT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFR CT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR CT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFR CT. In addition, >70% stenosis was significantly associated with low FFR CT (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001). CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR CT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.

AB - BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFR CT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFR CT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR CT. RESULTS: FFR CT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFR CT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR CT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFR CT. In addition, >70% stenosis was significantly associated with low FFR CT (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001). CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR CT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.

KW - Coronary artery disease

KW - FFR

KW - Ischemia

KW - Multivariate Analysis

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Incidence

KW - Coronary Stenosis/diagnostic imaging

KW - Europe/epidemiology

KW - Asia/epidemiology

KW - Female

KW - Registries

KW - Odds Ratio

KW - Coronary Angiography/methods

KW - North America/epidemiology

KW - Severity of Illness Index

KW - Multidetector Computed Tomography

KW - Reproducibility of Results

KW - Risk Factors

KW - Logistic Models

KW - Chi-Square Distribution

KW - Computed Tomography Angiography

KW - Coronary Artery Disease/diagnostic imaging

KW - Fractional Flow Reserve, Myocardial

KW - Aged

KW - Coronary Vessels/diagnostic imaging

U2 - 10.1016/j.jcct.2018.01.008

DO - 10.1016/j.jcct.2018.01.008

M3 - Journal article

VL - 12

SP - 95

EP - 100

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

SN - 1934-5925

IS - 2

ER -