TY - JOUR
T1 - Selective FFRCT testing in suspected stable angina in clinical practice
T2 - initial experiences
AU - Thangavel, Shifan
AU - Madsen, Kristian Taekker
AU - Rønnow Sand, Niels Peter
AU - Veien, Karsten Tange
AU - Deibjerg, Lone
AU - Husain, Majed
AU - Hosbond, Susanne
AU - Alan, Dilek Hunerel
AU - Øvrehus, Kristian Altern
AU - Junker, Anders
AU - Mortensen, Jonas
AU - Thomsen, Kristian Korsgaard
AU - Jensen, Lisette Okkels
AU - Poulsen, Tina Svenstrup
AU - Steffensen, Flemming Hald
AU - Rohold, Allan
AU - Busk, Martin
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/10
Y1 - 2024/10
N2 - Coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) is recommended for physiological assessment in intermediate coronary stenosis for guiding referral to invasive coronary angiography (ICA). In this study, we report real-world data on the feasibility of implementing a CTA/FFRCT test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30–89%) by CTA. Evaluation of CTA datasets, interpretation of FFRCT analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFRCT 375 (81%) and perfusion imaging 88 (19%). FFRCT analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFRCT was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFRCT-guided versus CTA-guided referral to ICA: 30–69% stenosis, 28 (44%) versus 8 (21%); 70–89% stenosis, 39 (69%) versus 25 (46%), respectively, both p < 0.05. Implementation of FFRCT at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate.
AB - Coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) is recommended for physiological assessment in intermediate coronary stenosis for guiding referral to invasive coronary angiography (ICA). In this study, we report real-world data on the feasibility of implementing a CTA/FFRCT test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30–89%) by CTA. Evaluation of CTA datasets, interpretation of FFRCT analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFRCT 375 (81%) and perfusion imaging 88 (19%). FFRCT analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFRCT was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFRCT-guided versus CTA-guided referral to ICA: 30–69% stenosis, 28 (44%) versus 8 (21%); 70–89% stenosis, 39 (69%) versus 25 (46%), respectively, both p < 0.05. Implementation of FFRCT at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate.
KW - Angina pectoris
KW - Computed tomography
KW - Coronary angiography
KW - Myocardial fractional flow reserve
KW - Myocardial revascularization
KW - Xray
KW - Predictive Value of Tests
KW - Prognosis
KW - Humans
KW - Middle Aged
KW - Angina, Stable/physiopathology
KW - Male
KW - Feasibility Studies
KW - Patient Selection
KW - Clinical Decision-Making
KW - Female
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Multidetector Computed Tomography
KW - Myocardial Perfusion Imaging/methods
KW - Computed Tomography Angiography
KW - Myocardial Revascularization
KW - Coronary Artery Disease/diagnostic imaging
KW - Coronary Angiography
KW - Fractional Flow Reserve, Myocardial
KW - Algorithms
KW - Coronary Stenosis/physiopathology
KW - Aged
KW - Referral and Consultation
KW - Coronary Vessels/diagnostic imaging
U2 - 10.1007/s10554-024-03214-8
DO - 10.1007/s10554-024-03214-8
M3 - Journal article
C2 - 39259436
AN - SCOPUS:85203500447
SN - 1569-5794
VL - 40
SP - 2213
EP - 2220
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 10
ER -