Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography Safely Defers Invasive Coronary Angiography in Patients with Stable Coronary Artery Disease.

OBJECTIVES

In the United States, the real-world feasibility and outcome of using fractional flow reserve from coronary computed tomography angiography (FFR) is unknown. We sought to determine whether a strategy that combined coronary computed tomography angiography (CTA) and FFR could safely reduce the need for invasive coronary angiography (ICA), as compared to coronary CTA alone.

METHODS

The study included 387 consecutive patients with suspected CAD referred for coronary CTA with selective FFR and 44 control patients who underwent CTA alone. Lesions with 30-90% diameter stenoses were considered of indeterminate hemodynamic significance and underwent FFR. Nadir FFR ≤ 0.80 was positive. The rate of patients having ICA, revascularization and major adverse cardiac events were recorded.

RESULTS

Using coronary CTA and selective FFR, 121 patients (32%) had at least one vessel with ≥50% diameter stenosis; 67/121 (55%) patients had at least one vessel with FFR ≤ 0.80; 55/121 (45%) underwent ICA; and 34 were revascularized. The proportion of ICA patients undergoing revascularization was 62% (34 of 55). The number of patients with vessels with 30-50% diameter of stenosis was 90 (23%); 28/90 (31%) patients had at least one vessel with FFR ≤ 0.80; 8/90 (9%) underwent ICA; and five were revascularized. In our institutional practice, compared to coronary CTA alone, coronary CTA with selective FFR reduced the rates of ICA (45% vs. 80%) for those with obstructive CAD. Using coronary CTA with selective FFR, no major adverse cardiac events occurred over a mean follow-up of 440 days.

CONCLUSION

FFR safely deferred ICA in patients with CAD of indeterminate hemodynamic significance. A high proportion of those who underwent ICA were revascularized.