Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
JACC Cardiovasc Imaging. 2017 May;10(5):541-550. doi: 10.1016/j.jcmg.2015.11.025. Epub 2016 Apr 13.
The goal of this study was to assess the real-world clinical utility of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFR) for decision-making in patients with stable coronary artery disease (CAD).
FFR has shown promising results in identifying lesion-specific ischemia. The real-world feasibility and influence on the diagnostic work-up of FFR testing in patients suspected of having CAD are unknown.
We reviewed the complete diagnostic work-up of nonemergent patients referred for coronary computed tomography angiography over a 12-month period at Aarhus University Hospital, Denmark, including all patients with new-onset chest pain with no known CAD and with intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred for FFR. The study evaluated the consequences on downstream diagnostic testing, the agreement between FFR and invasively measured FFR or instantaneous wave-free ratio (iFR), and the short-term clinical outcome after FFR testing.
Among 1,248 patients referred for computed tomography angiography, 189 patients (mean age 59 years; 59% male) were referred for FFR, with a conclusive FFR result obtained in 185 (98%). FFR was ≤0.80 in 31% of patients and 10% of vessels. After FFR testing, invasive angiography was performed in 29%, with FFR measured in 19% and iFR in 1% of patients (with a tendency toward declining FFR-iFR guidance during the study period). FFR ≤0.80 correctly classified 73% (27 of 37) of patients and 70% (37 of 53) of vessels using FFR ≤0.80 or iFR ≤0.90 as the reference standard. In patients with FFR >0.80 being deferred from invasive coronary angiography, no adverse cardiac events occurred during a median follow-up period of 12 (range 6 to 18 months) months.
FFR testing is feasible in real-world symptomatic patients with intermediate-range stenosis determined by coronary computed tomography angiography. Implementation of FFR for clinical decision-making may influence the downstream diagnostic workflow of patients. Patients with an FFR value >0.80 being deferred from invasive coronary angiography have a favorable short-term prognosis.
本研究旨在评估基于冠状动脉计算机断层扫描血管造影术（CTA）的血流储备分数（FFR）在稳定型冠状动脉疾病（CAD）患者中的实际临床应用价值。
FFR 在识别特定病变缺血方面显示出良好的效果。目前尚不清楚在疑似 CAD 患者中，FFR 检测的实际可行性及其对诊断工作流程的影响。
我们回顾了丹麦奥胡斯大学医院在 12 个月期间对所有新发胸痛且无已知 CAD 且存在中等程度狭窄（管腔狭窄 30%至 70%）的患者进行冠状动脉 CTA 检查的非紧急患者的完整诊断工作流程，这些患者被转介进行 FFR 检查。该研究评估了其对下游诊断检测的影响、FFR 与有创测量 FFR 或瞬时无波比（iFR）之间的一致性，以及 FFR 检测后的短期临床结果。
在 1248 例接受 CTA 检查的患者中，有 189 例（平均年龄 59 岁；59%为男性）患者被转介进行 FFR 检查，其中 185 例（98%）获得了明确的 FFR 结果。31%的患者和 10%的血管 FFR 值≤0.80。在 FFR 检查后，29%的患者进行了有创血管造影检查，19%的患者测量了 FFR，1%的患者测量了 iFR（研究期间 FFR-iFR 指导的趋势呈下降趋势）。使用 FFR≤0.80 或 iFR≤0.90 作为参考标准，FFR≤0.80 正确分类了 73%（37/53）的患者和 70%（37/53）的血管。对于 FFR>0.80 的患者，从中度狭窄中获益，从中度狭窄中获益，在中位随访 12 个月（6 至 18 个月）期间，无不良心脏事件发生。
在通过冠状动脉 CTA 检查确定的中度狭窄的有症状的真实世界患者中，FFR 检查是可行的。FFR 用于临床决策可能会影响患者的下游诊断工作流程。FFR 值>0.80 的患者从中度狭窄中获益，被推迟进行有创性冠状动脉造影检查，具有良好的短期预后。
