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
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