Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions

Influence on Downstream Diagnostic workflows and invasive angiography findings

Bjarne L. Nørgaard*, Lars C. Gormsen, Hans Erik Bøtker, Erik Parner, Lene H. Nielsen, Ole N. Mathiassen, Erik L. Grove, Kristian A. Øvrehus, Sara Gaur, Jonathon Leipsic, Kamilla Pedersen, Christian J. Terkelsen, Evald H. Christiansen, Anne Kaltoft, Michael Mæng, Steen D. Kristensen, Lars R. Krusell, Jens F. Lassen, Jesper M. Jensen

*Kontaktforfatter for dette arbejde

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Resumé

Background--Data on the clinical utility of coronary computed tomography angiography-derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40-70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization). Methods and Results--This was a single-center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT "implementation" (n=800) or "clinical use" (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference:-4.2; 95% CI,-6.9 to-1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (-12.8%; 95% CI,-22.2 to-3.4; P=0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3-24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3-44.4; P < 0.001) after clinical adoption of FFRCT. Conclusions--Replacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.

OriginalsprogEngelsk
Artikelnummere005587
TidsskriftJournal of the American Heart Association
Vol/bind6
Udgave nummer8
Antal sider13
ISSN2047-9980
DOI
StatusUdgivet - 2017

Fingeraftryk

Workflow
Coronary Angiography
Coronary Artery Disease
Propensity Score
Computed Tomography Angiography

Citer dette

Nørgaard, Bjarne L. ; Gormsen, Lars C. ; Bøtker, Hans Erik ; Parner, Erik ; Nielsen, Lene H. ; Mathiassen, Ole N. ; Grove, Erik L. ; Øvrehus, Kristian A. ; Gaur, Sara ; Leipsic, Jonathon ; Pedersen, Kamilla ; Terkelsen, Christian J. ; Christiansen, Evald H. ; Kaltoft, Anne ; Mæng, Michael ; Kristensen, Steen D. ; Krusell, Lars R. ; Lassen, Jens F. ; Jensen, Jesper M. / Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions : Influence on Downstream Diagnostic workflows and invasive angiography findings. I: Journal of the American Heart Association. 2017 ; Bind 6, Nr. 8.
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title = "Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions: Influence on Downstream Diagnostic workflows and invasive angiography findings",
abstract = "Background--Data on the clinical utility of coronary computed tomography angiography-derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40-70{\%}) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization). Methods and Results--This was a single-center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT {"}implementation{"} (n=800) or {"}clinical use{"} (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference:-4.2; 95{\%} CI,-6.9 to-1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (-12.8{\%}; 95{\%} CI,-22.2 to-3.4; P=0.008) and rate of coronary revascularization increased (14.1{\%}; 95{\%} CI, 3.3-24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8{\%}; 95{\%} CI, 11.3-44.4; P < 0.001) after clinical adoption of FFRCT. Conclusions--Replacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.",
keywords = "Computed tomography angiography, Coronary artery disease, Imaging, Positron emission tomography",
author = "N{\o}rgaard, {Bjarne L.} and Gormsen, {Lars C.} and B{\o}tker, {Hans Erik} and Erik Parner and Nielsen, {Lene H.} and Mathiassen, {Ole N.} and Grove, {Erik L.} and {\O}vrehus, {Kristian A.} and Sara Gaur and Jonathon Leipsic and Kamilla Pedersen and Terkelsen, {Christian J.} and Christiansen, {Evald H.} and Anne Kaltoft and Michael M{\ae}ng and Kristensen, {Steen D.} and Krusell, {Lars R.} and Lassen, {Jens F.} and Jensen, {Jesper M.}",
year = "2017",
doi = "10.1161/JAHA.117.005587",
language = "English",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "8",

}

Nørgaard, BL, Gormsen, LC, Bøtker, HE, Parner, E, Nielsen, LH, Mathiassen, ON, Grove, EL, Øvrehus, KA, Gaur, S, Leipsic, J, Pedersen, K, Terkelsen, CJ, Christiansen, EH, Kaltoft, A, Mæng, M, Kristensen, SD, Krusell, LR, Lassen, JF & Jensen, JM 2017, 'Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions: Influence on Downstream Diagnostic workflows and invasive angiography findings', Journal of the American Heart Association, bind 6, nr. 8, e005587. https://doi.org/10.1161/JAHA.117.005587

Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions : Influence on Downstream Diagnostic workflows and invasive angiography findings. / Nørgaard, Bjarne L.; Gormsen, Lars C.; Bøtker, Hans Erik; Parner, Erik; Nielsen, Lene H.; Mathiassen, Ole N.; Grove, Erik L.; Øvrehus, Kristian A.; Gaur, Sara; Leipsic, Jonathon; Pedersen, Kamilla; Terkelsen, Christian J.; Christiansen, Evald H.; Kaltoft, Anne; Mæng, Michael; Kristensen, Steen D.; Krusell, Lars R.; Lassen, Jens F.; Jensen, Jesper M.

I: Journal of the American Heart Association, Bind 6, Nr. 8, e005587, 2017.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Myocardial perfusion imaging versus computed tomography angiography-derived fractional flow reserve testing in stable patients with intermediate-range coronary lesions

T2 - Influence on Downstream Diagnostic workflows and invasive angiography findings

AU - Nørgaard, Bjarne L.

AU - Gormsen, Lars C.

AU - Bøtker, Hans Erik

AU - Parner, Erik

AU - Nielsen, Lene H.

AU - Mathiassen, Ole N.

AU - Grove, Erik L.

AU - Øvrehus, Kristian A.

AU - Gaur, Sara

AU - Leipsic, Jonathon

AU - Pedersen, Kamilla

AU - Terkelsen, Christian J.

AU - Christiansen, Evald H.

AU - Kaltoft, Anne

AU - Mæng, Michael

AU - Kristensen, Steen D.

AU - Krusell, Lars R.

AU - Lassen, Jens F.

AU - Jensen, Jesper M.

PY - 2017

Y1 - 2017

N2 - Background--Data on the clinical utility of coronary computed tomography angiography-derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40-70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization). Methods and Results--This was a single-center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT "implementation" (n=800) or "clinical use" (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference:-4.2; 95% CI,-6.9 to-1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (-12.8%; 95% CI,-22.2 to-3.4; P=0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3-24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3-44.4; P < 0.001) after clinical adoption of FFRCT. Conclusions--Replacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.

AB - Background--Data on the clinical utility of coronary computed tomography angiography-derived fractional flow reserve (FFRCT) are sparse. In patients with intermediate (40-70%) coronary stenosis determined by coronary computed tomography angiography, we investigated the association of replacing standard myocardial perfusion imaging with FFRCT testing with downstream utilization of invasive coronary angiography (ICA) and the diagnostic yield of ICA (rate of no obstructive disease, and rate of revascularization). Methods and Results--This was a single-center observational study of symptomatic patients with suspected coronary artery disease referred to coronary computed tomography angiography between 2013 and 2015. Patients were divided into 3 historical groups based on the adjunctive functional testing approach: myocardial perfusion imaging (n=1332) or FFRCT "implementation" (n=800) or "clinical use" (n=1391). Propensity score matching was used to estimate the average period effect on outcomes. Patients in the FFRCT clinical use group versus the myocardial perfusion imaging group were older and had higher pretest probability of obstructive disease. After adjusting for baseline risk characteristics, there was a reduction in downstream ICA utilization (absolute risk difference:-4.2; 95% CI,-6.9 to-1.6; P=0.002). In patients referred to ICA, findings of no obstructive coronary artery disease decreased (-12.8%; 95% CI,-22.2 to-3.4; P=0.008) and rate of coronary revascularization increased (14.1%; 95% CI, 3.3-24.9; P=0.01), as did availability of functional information for guidance of revascularization (27.8%; 95% CI, 11.3-44.4; P < 0.001) after clinical adoption of FFRCT. Conclusions--Replacing adjunctive myocardial perfusion imaging with FFRCT testing for functional assessment of intermediate stenosis determined by coronary computed tomography angiography in stable coronary artery disease was associated with less ICA utilization, and a higher ICA diagnostic yield. The findings in this observational study needs confirmation in prospective, randomized trials.

KW - Computed tomography angiography

KW - Coronary artery disease

KW - Imaging

KW - Positron emission tomography

U2 - 10.1161/JAHA.117.005587

DO - 10.1161/JAHA.117.005587

M3 - Journal article

VL - 6

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 8

M1 - e005587

ER -