Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial.

Autor: Andreini D; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.).; Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A.), University of Milan, Italy., Modolo R; Department of Cardiology, Amsterdam University Medical Center, the Netherlands (R.M., Y.K.).; Department of Internal Medicine, Cardiology Division, Hospital de Clinicas, University of Campinas, SP, Brazil (R.M.)., Katagiri Y; Department of Cardiology, Amsterdam University Medical Center, the Netherlands (R.M., Y.K.)., Mushtaq S; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Sonck J; Cardiovascular Center Aalst, OLV Hospital, Belgium (J.S., C.C.)., Collet C; Cardiovascular Center Aalst, OLV Hospital, Belgium (J.S., C.C.)., De Martini S; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Roberto M; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Tanaka K; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (K.T., J.C., D.S.)., Miyazaki Y; Thoraxcenter, Erasmus MC, the Netherlands (Y.M., Y.O.)., Czapla J; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (K.T., J.C., D.S.)., Schoors D; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (K.T., J.C., D.S.)., Plass A; University of Zurich, Switzerland (A.P., F.M., P.K.)., Maisano F; University of Zurich, Switzerland (A.P., F.M., P.K.)., Kaufmann P; University of Zurich, Switzerland (A.P., F.M., P.K.)., Orry X; CHRU Nancy and Universite de Lorraine, Nancy, France (X.O., P.-A.M., T.F.)., Metzdorf PA; CHRU Nancy and Universite de Lorraine, Nancy, France (X.O., P.-A.M., T.F.)., Folliguet T; CHRU Nancy and Universite de Lorraine, Nancy, France (X.O., P.-A.M., T.F.)., Färber G; Jena University Hospital, Friedrich Schiller University of Jena, Germany (G.F., I.D.)., Diamantis I; Jena University Hospital, Friedrich Schiller University of Jena, Germany (G.F., I.D.)., Schönweiß M; Heinrich Braun Klinikum, Zwickau, Germany (M.S.)., Bonalumi G; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Guglielmo M; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Ferrari C; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Olivares P; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Cavallotti L; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.)., Leal I; Cardialysis BV, Rotterdam, the Netherlands (I.L., W.L.)., Lindeboom W; Cardialysis BV, Rotterdam, the Netherlands (I.L., W.L.)., Onuma Y; Thoraxcenter, Erasmus MC, the Netherlands (Y.M., Y.O.)., Serruys PW; Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, United Kingdom (P.W.S.)., Bartorelli AL; Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.).; Department of Biomedical and Clinical Sciences 'Luigi Sacco' (A.L.B.), University of Milan, Italy.
Jazyk: angličtina
Zdroj: Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2019 Dec; Vol. 12 (12), pp. e007607. Date of Electronic Publication: 2019 Dec 13.
DOI: 10.1161/CIRCINTERVENTIONS.118.007607
Abstrakt: Background: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFR CT ) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFR CT on heart team's treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease.
Methods: The trial was an international, multicenter study randomizing 2 heart teams to make a treatment decision between percutaneous coronary interventions and coronary artery bypass grafting using either coronary computed tomography angiography or conventional angiography. The heart teams received the FFR CT and had to make a treatment decision and planning integrating the functional component of the stenoses. Each heart team calculated the anatomic SYNTAX score, the noninvasive functional SYNTAX score and subsequently integrated the clinical information to compute the SYNTAX score III providing a treatment recommendation, that is, coronary artery bypass grafting, percutaneous coronary intervention, or equipoise coronary artery bypass grafting-percutaneous coronary intervention. The primary objective was to determine the proportion of patients in whom FFR CT changed the treatment decision and planning.
Results: Overall, 223 patients were included. Coronary computed tomography angiography assessment was feasible in 99% of the patients and FFR CT analysis in 88%. FFR CT was available for 1030 lesions (mean FFR CT value 0.64±13). A treatment recommendation of coronary artery bypass grafting was made in 24% of the patients with coronary computed tomography angiography with FFR CT . The addition of FFR CT changed the treatment decision in 7% of the patients and modified selection of vessels for revascularization in 12%. With conventional angiography as reference, FFR CT assessment resulted in reclassification of 14% of patients from intermediate and high to low SYNTAX score tertile.
Conclusions: In patients with 3-vessel coronary artery disease, a noninvasive physiology assessment using FFR CT changed heart team's treatment decision-making and procedural planning in one-fifth of the patients.
Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02813473.
Databáze: MEDLINE
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