Mickley Hans, Veien Karsten T, Gerke Oke, Lambrechtsen Jess, Rohold Allan, Steffensen Flemming H, Husic Mirza, Akkan Dilek, Busk Martin, Jessen Louise B, Jensen Lisette O, Diederichsen Axel, Øvrehus Kristian A
Department of Cardiology, Odense University Hospital, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Denmark.
JACC Cardiovasc Imaging. 2022 Jun;15(6):1046-1058. doi: 10.1016/j.jcmg.2021.12.010. Epub 2022 Feb 16.
The influence of extensive coronary calcifications on the diagnostic and prognostic value of coronary computed tomography angiography-derived fractional flow reserve (FFR) has been scantily investigated.
The purpose of this study was to investigate the diagnostic and short-term role of FFR in chest pain patients with Agatston score (AS) >399.
This was a prospective multicenter study of 260 stable patients with suspected coronary artery disease (CAD) and AS >399. FFR was measured blinded by an independent core laboratory. All patients underwent invasive coronary angiography (ICA) and FFR if indicated. The agreement of FFR ≤0.80 with hemodynamically significant CAD on ICA/FFR (≥50% left main or ≥70% epicardial artery stenosis and/or FFR ≤0.80) was assessed. Patients undergoing FFR had colocation FFR measured, and the lowest per-patient FFR was registered in all patients. The association among per-patient FFR, coronary revascularization, and major clinical events (all-cause mortality, myocardial infarction, or unstable angina hospitalization) at 90-day follow-up was evaluated.
Median age and AS were 68.5 years (IQR: 63-74 years) and 895 (IQR: 587-1,513), respectively. FFR was ≤0.80 in 204 patients (78%). Colocation FFR (n = 112) showed diagnostic accuracy, sensitivity, and specificity to identify hemodynamically significant CAD of 71%, 87%, and 54%. The area under the receiver-operating characteristics curve (AUC) was 0.75. When using the lowest FFR (n = 260), per-patient accuracy, sensitivity, and specificity were 57%, 95%, and 32%, respectively. The AUC was 0.84. A total of 85 patients underwent revascularization, and FFR was ≤0.80 in 96% of these. During follow-up, major clinical events occurred in 3 patients (1.2%), all with FFR ≤0.80.
Most patients with AS >399 had FFR ≤0.80. Using ICA/FFR as the reference revealed a moderate diagnostic accuracy of colocation FFR. Compared with the lowest per-patient FFR, colocation FFR measurement improved diagnostic accuracy and specificity. The 90-day follow-up was favorable with few coronary revascularizations and no major clinical events occurring in patients with FFR >0.80. (Use of FFR-CT in Stable Intermediate Chest Pain Patients With Severe Coronary Calcium Score [FACC]; NCT03548753).
广泛冠状动脉钙化对冠状动脉计算机断层扫描血管造影衍生的血流储备分数（FFR）的诊断和预后价值的影响鲜有研究。
本研究旨在探讨FFR在阿加斯顿评分（AS）>399的胸痛患者中的诊断及短期作用。
这是一项针对260例疑似冠心病（CAD）且AS>399的稳定患者的前瞻性多中心研究。FFR由独立核心实验室在盲态下测量。所有患者均接受有创冠状动脉造影（ICA），必要时测量FFR。评估FFR≤0.80与ICA/FFR上血流动力学显著CAD（左主干≥50%或心外膜动脉狭窄≥70%和/或FFR≤0.80）的一致性。接受FFR测量的患者进行了共置FFR测量，并记录所有患者的最低个体FFR。评估个体FFR、冠状动脉血运重建和90天随访时的主要临床事件（全因死亡率、心肌梗死或不稳定型心绞痛住院）之间的关联。
中位年龄和AS分别为68.5岁（四分位间距：63 - 74岁）和895（四分位间距：587 - 1513）。204例患者（78%）的FFR≤0.80。共置FFR（n = 112）对识别血流动力学显著CAD的诊断准确性、敏感性和特异性分别为71%、87%和54%。受试者工作特征曲线（AUC）下面积为0.75。使用最低FFR（n = 260）时，个体准确性、敏感性和特异性分别为57%、95%和32%。AUC为0.84。共有85例患者接受了血运重建，其中96%的患者FFR≤0.80。随访期间，3例患者（1.2%）发生了主要临床事件，均为FFR≤0.80。
大多数AS>399的患者FFR≤0.80。以ICA/FFR为参考，共置FFR显示出中等诊断准确性。与最低个体FFR相比，共置FFR测量提高了诊断准确性和特异性。90天随访结果良好，FFR>0.80的患者冠状动脉血运重建较少，未发生主要临床事件。（严重冠状动脉钙化评分的稳定中度胸痛患者中FFR-CT的应用[FACC]；NCT03548753）
