1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT
Autor: | Timothy A. Fairbairn, Jonathon Leipsic, Hitoshi Matsuo, Gianluca Pontone, Niels Peter Rønnow Sand, Bjarne L. Nørgaard, Tomohiro Kawasaki, Campbell Rogers, Manesh R. Patel, Michael Poon, Bernard De Bruyne, Jesper M. Jensen, Koen Nieman, Jeroen Sonck, Tetsuya Amano, Gilbert L. Raff, Lynne M. Hurwitz Koweek, Takashi Akasaka, Mark G. Rabbat, Jeroen J. Bax, Kristian A. Øvrehus, Daniel S. Berman, Sarah Mullen |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Time Factors Computed Tomography Angiography medicine.medical_treatment Myocardial Infarction Coronary Artery Disease Fractional flow reserve 030204 cardiovascular system & hematology Coronary Angiography Chest pain Revascularization Risk Assessment 030218 nuclear medicine & medical imaging Coronary artery disease 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Cause of Death Internal medicine Myocardial Revascularization medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Registries Myocardial infarction Aged business.industry Coronary Stenosis Middle Aged Prognosis medicine.disease Coronary Vessels Fractional Flow Reserve Myocardial Relative risk Disease Progression Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Mace |
Zdroj: | JACC: Cardiovascular Imaging. 13:97-105 |
ISSN: | 1936-878X |
DOI: | 10.1016/j.jcmg.2019.03.003 |
Popis: | Objectives The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. Background Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Methods Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. Results At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFRCT ≤0.80 and in 89 (5.60%) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p 0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFRCT ≤0.80 compared with 10 (0.60%) patients with an FFRCT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT ≤0.80 compared with patients with an FFRCT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). Conclusions The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679) |
Databáze: | OpenAIRE |
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