Completeness of revascularization by FFR CT in stable angina: Association to adverse cardiovascular outcomes.

Autor: Madsen KT; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark. Electronic address: kristian.taekker.madsen2@rsyd.dk., Nørgaard BL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Øvrehus KA; Department of Cardiology, Odense University Hospital, Odense, Denmark., Jensen JM; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Parner E; Department of Public Health, Section for Biostatistics, Aarhus University, Denmark., Grove EL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Mortensen MB; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Iraqi N; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Fairbairn TA; Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Nieman K; Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA., Patel MR; Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA., Rogers C; HeartFlow Inc., Mountain View, CA, USA., Mullen S; HeartFlow Inc., Mountain View, CA, USA., Mickley H; Department of Cardiology, Odense University Hospital, Odense, Denmark., Thomsen KK; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark., Bøtker HE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Leipsic J; Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada., Rønnow Sand NP; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
Jazyk: angličtina
Zdroj: Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2024 Sep-Oct; Vol. 18 (5), pp. 494-502. Date of Electronic Publication: 2024 Jul 17.
DOI: 10.1016/j.jcct.2024.07.007
Abstrakt: Background: The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.
Objectives: To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR CT ) and cardiovascular outcomes in patients with stable angina.
Methods: Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR CT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR CT ≤ 0.80 were categorized as: Completely revascularized (CR-FFR CT ), all vessels with FFR CT ≤ 0.80 revascularized; incompletely revascularized (IR-FFR CT ), ≥ 1 vessels with FFR CT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
Results: Amongst 900 patients and 1759 vessels, FFR CT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR CT (15/210 [7.1%]) compared to CR-FFR CT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01-8.8, p ​= ​0.036, and to normal FFR CT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6-42.6, p ​< ​0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFR CT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFR CT ≤ 0.80 (5/286 [1.7%]), p ​= ​0.001, and to vessels with FFR CT > 0.80 (10/1223 [0.8%]), p ​< ​0.001.
Conclusion: Incomplete revascularization of patients with lesion-specific FFR CT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFR CT > 0.80.
Competing Interests: Declaration of competing interest CR is a full-time employee of HeartFlow, and receives salary and stock options from HeartFlow. ELG has no conflicts related to this manuscript but has received speaker honoraria or consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Lundbeck Pharma, Novo Nordisk and Organon. He is investigator in clinical studies sponsored by AstraZeneca, Idorsia or Bayer and has received unrestricted research grants from Boehringer Ingelheim. JL is a consultant and holds stock options in Circle CVI and HeartFlow. KN acknowledges support from the NIH and reports unrestricted institutional research support from Siemens Healthineers, Bayer, HeartFlow Inc and Novartis. MP has received research grants from Janssen, Bayer, Heartflow and NIH and is part of the following advisory boards: Janssen, Bayer, Heartflow, Phillips. SM is a full-time employee of HeartFlow, and shareholder of HeartFlow. TF is associated with the HeartFlow speakers bureau. All other authors had no disclosures to declare.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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