FFR-CT prognostic of long-term outcomes in patients with stable angina
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Key takeaways:
- Abnormal FFR-CT findings were significantly prognostic of poor long-term outcomes in patients with stable angina.
- Those with high CAC scores were at especially high risk, researchers reported.
Danish researchers reported that CT angiography-derived fractional flow reserve was significantly prognostic of all-cause death and acute MI in patients with stable angina, especially those with high coronary calcium scores.
The results of a long-term follow-up analysis of the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry were published in Radiology.
Image: Adobe Stock
“CT angiography is the first step in identifying the presence of coronary artery disease, but it doesn’t show the impact on blood flow in the arteries,” Kristian T. Madsen, MD, PhD candidate in the department of cardiology at the University Hospital of Southern Denmark in Esbjerg, said in a press release. “Turbulent blood flow may create abnormal pressure in the vessel that grinds down coronary plaques, making them prone to rupture.”
To better understand the prognostic value of FFR-CT (HeartFlow) beyond 1 year in patients with stable angina and high CAC, Madsen and colleagues enrolled 900 patients at the three Danish sites participating in the ADVANCE registry from December 2015 to October 2017. The median follow-up was 2.2 years.
High CAC was defined as Agatston score of at least 400, whereas a lesion-specific coronary FFR-CT value of 2 cm with distal-to-stenosis value of 0.8 or less represented an abnormal test result.
Prognostic value of FFR-CT in stable angina
The study included 523 participants with normal results on FFR-CT (mean age, 64 years; 61% men) and 377 with abnormal results (mean age, 65 years; 264 men).
The primary endpoint was a composite of all-cause mortality and nonfatal spontaneous MI and occurred in 2.1% of those with normal FFR-CT results and 6.6% with abnormal results.
Madsen and colleagues reported that the rate of the primary endpoint translated to an RR of 3.1 among patients with abnormal FFR-CT results (95% CI, 1.6-6.3; P < .001).
Among a subgroup of patients with high CAC, the primary endpoint occurred in 2.2% with normal FFR-CT results and 9% with abnormal results, translating to an RR of 4.1 among those with abnormal findings (95% CI, 1.4-11.8; P = .001).
“Our study provides evidence for the prognostic potential of CT-FFR in patients with high coronary artery calcium scores,” Madsen said in the release. “Regardless of the patient’s baseline risk and extent of coronary artery disease measured by coronary artery calcium, if CT-FFR results are normal, the prognosis is good.
“In my opinion, CT-FFR is the best option because it provides a blood-flow estimate similar to what you would obtain if you performed invasive heart catheterization,” he said. “You get a reliable and quick answer without performing additional tests or putting the patient through an invasive procedure.”
‘The right balance’ of diagnostic tools
In a related editorial, Valentin Sinitsyn, MD, PhD, head of the radiology department at the University Hospital of Moscow, Lomonosov State University, discussed the results of the present study and the future of FFR-CT.
“The most important finding in the study by Madsen et al is a clear demonstration that the independent prognostic value of coronary CTA-derived FFR extends up to 3 years,” Sinitsyn wrote. “Previous studies demonstrated the prognostic value of coronary CTA-derived FFR within a 1-year follow-up. This result further promotes the use of this important and convenient technique for triage and treatment of patients with CAD with stable disease.
“The value and role of these modalities are constantly changing due to technical progress, ongoing clinical research and accumulation of practical experience,” he wrote. “The integration of CT or MRI myocardial perfusion and coronary CTA-derived CT in the diagnostic workup of patients with CAD still represents a challenging task. The search for the right balance between these diagnostic modalities in different health care models will remain one of the most important fields of research.”
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