Duguay Taylor M, Tesche Christian, Vliegenthart Rozemarijn, De Cecco Carlo N, Lin Han, Albrecht Moritz H, Varga-Szemes Akos, De Santis Domenico, Ebersberger Ullrich, Bayer Richard R, Litwin Sheldon E, Hoffmann Ellen, Steinberg Daniel H, Schoepf U Joseph
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina.
Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
Am J Cardiol. 2017 Oct 15;120(8):1260-1266. doi: 10.1016/j.amjcard.2017.07.008. Epub 2017 Jul 25.
This study investigated the prognostic value of coronary computed tomography angiography (cCTA)-derived fractional flow reserve (CT-FFR) in patients with acute coronary syndrome (ACS) and multivessel disease to gauge significance and guide management of non-culprit lesions. We retrospectively analyzed data of 48 patients (56 ± 10 years, 60% men) who were admitted for symptoms suggestive of ACS and underwent dual-source cCTA followed by invasive coronary angiography with culprit lesion intervention. Culprit lesions were retrospectively identified on cCTA using images obtained during invasive coronary angiography. Non-culprit lesions with ≥25% luminal stenosis and deferred intervention were evaluated using a machine learning CT-FFR algorithm to determine lesion-specific ischemia (CT-FFR ≤0.80). Follow-up was performed. CT-FFR identified lesion-specific ischemia in 23 of 81 non-culprit lesions. After a median follow-up of 19.5 months, 14 patients (29%) had major adverse cardiac events (MACE). Univariate Cox regression analysis revealed that CT-FFR ≤0.80 (hazard ratio [HR] 3.77 [95% confidence interval 1.16 to 12.29], p = 0.027), Framingham risk score (FRS) (HR 2.96 [1.01 to 7.63], p = 0.038), and a CAD-RADS classification ≥3 (HR 3.12 [1.03 to 10.17], p = 0.051) were predictors of MACE. In a risk-adjusted model controlling for FRS and CAD-RADS ≥3, CT-FFR ≤0.80 remained a predictor of MACE (1.56 [1.01 to 2.83], p = 0.048). Receiver operating characteristics analysis including FRS, CAD-RADS ≥ 3, and CT-FFR ≤0.80 (area under the curve 0.78) showed incremental discriminatory power over FRS alone (area under the curve 0.66, p = 0.032). CT-FFR of non-culprit lesions in patients with ACS and multivessel disease adds prognostic value to identify risk of future MACE.
本研究调查了冠状动脉计算机断层扫描血管造影（cCTA）衍生的血流储备分数（CT-FFR）在急性冠状动脉综合征（ACS）和多支血管病变患者中的预后价值，以评估非罪犯病变的意义并指导其管理。我们回顾性分析了48例患者（年龄56±10岁，男性占60%）的数据，这些患者因提示ACS的症状入院，接受了双源cCTA检查，随后进行了罪犯病变干预的有创冠状动脉造影。使用有创冠状动脉造影期间获得的图像在cCTA上回顾性识别罪犯病变。对管腔狭窄≥25%且延迟干预的非罪犯病变，使用机器学习CT-FFR算法评估以确定病变特异性缺血（CT-FFR≤0.80）。进行了随访。CT-FFR在81个非罪犯病变中的23个中识别出病变特异性缺血。中位随访19.5个月后，14例患者（29%）发生了主要不良心脏事件（MACE）。单因素Cox回归分析显示，CT-FFR≤0.80（风险比[HR]3.77[95%置信区间1.16至12.29]，p = 0.027）、弗雷明汉风险评分（FRS）（HR 2.96[1.01至7.63]，p = 0.038）以及CAD-RADS分类≥3（HR 3.12[1.03至10.17]，p = 0.051）是MACE的预测因素。在控制FRS和CAD-RADS≥3的风险调整模型中，CT-FFR≤0.80仍然是MACE的预测因素（1.56[1.01至2.83]，p = 0.048）。包括FRS、CAD-RADS≥3和CT-FFR≤0.80的受试者工作特征分析（曲线下面积0.78）显示，其鉴别能力优于单独的FRS（曲线下面积0.66，p = 0.032）。ACS和多支血管病变患者中非罪犯病变的CT-FFR为识别未来发生MACE的风险增加了预后价值。
