Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study

Kristian Tækker Madsen*, Bjarne Linde Nørgaard, Kristian Altern Øvrehus, Jesper Møller Jensen, Erik Parner, Erik Lerkevang Grove, Martin B. Mortensen, Timothy A. Fairbairn, Koen Nieman, Manesh R. Patel, Campbell Rogers, Sarah Mullen, Hans Mickley, Kristian Korsgaard Thomsen, Hans Erik Bøtker, Jonathon Leipsic, Niels Peter Rønnow Sand

*Corresponding author for this work

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Abstract

Background: The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFRCT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. Methods: Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 ​% coronary stenosis. A per-patient lowest FFRCT-value ≤0.80 represented an abnormal test result. Patients with FFRCT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFRCT) ≥1 vessels with FFRCT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. Results: Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFRCT ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFRCT ≤0.80 vs ​> ​0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 ​% CI: 1.31–2.52, p ​< ​0.001. Risk of recurrent angina in CR-FFRCT (n ​= ​135) was similar to patients with FFRCT >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62–1.40, p ​= ​0.72, while IR-FFRCT (n ​= ​90) and non-revascularized patients with FFRCT ≤0.80 (n ​= ​285) had increased risk, 37 ​% vs 15 ​% RR: 2.50; 95 ​% CI: 1.68–3.73, p ​< ​0.001 and 30 ​% vs 15 ​%, RR: 2.03; 95 ​% CI: 1.44–2.87, p ​< ​0.001, respectively. Use of antianginal medication was similar across study groups. Conclusion: In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFRCT provides information regarding risk of recurrent angina.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
Volume18
Issue number3
Pages (from-to)243-250
ISSN1934-5925
DOIs
Publication statusPublished - 1. May 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors

Keywords

  • Angina
  • Complete revascularization
  • Coronary computed tomography angiography
  • Coronary revascularization
  • FFR
  • Recurrent angina
  • Stable angina pectoris
  • Predictive Value of Tests
  • Recurrence
  • Prognosis
  • Follow-Up Studies
  • Angina, Stable/physiopathology
  • Humans
  • Middle Aged
  • Male
  • Coronary Stenosis/diagnostic imaging
  • Time Factors
  • Female
  • Severity of Illness Index
  • Risk Assessment
  • Risk Factors
  • Computed Tomography Angiography
  • Coronary Angiography
  • Fractional Flow Reserve, Myocardial
  • Aged
  • Coronary Vessels/diagnostic imaging

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