Author + information
- Received September 11, 2015
- Revision received November 4, 2015
- Accepted November 10, 2015
- Published online May 1, 2017.
- Bjarne L. Nørgaard, MD, PhDa,∗ (, )
- Jakob Hjort, MPHa,
- Sara Gaur, MDa,
- Nicolaj Hansson, MDa,
- Hans Erik Bøtker, MD, DMScia,
- Jonathon Leipsic, MD, PhDb,
- Ole N. Mathiassen, MD, PhDa,
- Erik L. Grove, MD, PhDa,c,
- Kamilla Pedersen, BSca,
- Evald H. Christiansen, MD, PhDa,
- Anne Kaltoft, MD, PhDa,
- Lars C. Gormsen, MD, PhDd,
- Michael Mæng, MD, PhDa,
- Christian J. Terkelsen, MD, DMScia,
- Steen D. Kristensen, MD, DMScia,
- Lars R. Krusell, MDa and
- Jesper M. Jensen, MD, PhDa
- aDepartment of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
- bDepartment of Radiology, St. Paul’s Hospital, University of British Columbia, British Columbia, Canada
- cFaculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- dDepartment of Nuclear Medicine, Aarhus University Hospital Skejby, Aarhus, Denmark
- ↵∗Address for correspondence:
Dr. Bjarne L. Nørgaard, Department of Cardiology, Aarhus University Hospital Skejby, Skejby DK-8200 Aarhus N, Denmark.
Objectives The goal of this study was to assess the real-world clinical utility of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) for decision-making in patients with stable coronary artery disease (CAD).
Background FFRCT has shown promising results in identifying lesion-specific ischemia. The real-world feasibility and influence on the diagnostic work-up of FFRCT testing in patients suspected of having CAD are unknown.
Methods We reviewed the complete diagnostic work-up of nonemergent patients referred for coronary computed tomography angiography over a 12-month period at Aarhus University Hospital, Denmark, including all patients with new-onset chest pain with no known CAD and with intermediate-range coronary lesions (lumen reduction, 30% to 70%) referred for FFRCT. The study evaluated the consequences on downstream diagnostic testing, the agreement between FFRCT and invasively measured FFR or instantaneous wave-free ratio (iFR), and the short-term clinical outcome after FFRCT testing.
Results Among 1,248 patients referred for computed tomography angiography, 189 patients (mean age 59 years; 59% male) were referred for FFRCT, with a conclusive FFRCT result obtained in 185 (98%). FFRCT was ≤0.80 in 31% of patients and 10% of vessels. After FFRCT testing, invasive angiography was performed in 29%, with FFR measured in 19% and iFR in 1% of patients (with a tendency toward declining FFR-iFR guidance during the study period). FFRCT ≤0.80 correctly classified 73% (27 of 37) of patients and 70% (37 of 53) of vessels using FFR ≤0.80 or iFR ≤0.90 as the reference standard. In patients with FFRCT >0.80 being deferred from invasive coronary angiography, no adverse cardiac events occurred during a median follow-up period of 12 (range 6 to 18 months) months.
Conclusions FFRCT testing is feasible in real-world symptomatic patients with intermediate-range stenosis determined by coronary computed tomography angiography. Implementation of FFRCT for clinical decision-making may influence the downstream diagnostic workflow of patients. Patients with an FFRCT value >0.80 being deferred from invasive coronary angiography have a favorable short-term prognosis.
Drs. Nørgaard and Hansson have received unrestricted research grants from Edwards Lifesciences. Dr. Leipsic has received speakers honorarium from GE Healthcare; and is a consultant for Edwards Lifesciences and HeartFlow. Dr. Grove has received speaker honoraria from AstraZeneca, Baxter, Bayer, Boehringer Ingelheim, and Pfizer; and has participated in advisory board meetings for AstraZeneca, Bayer, Boehringer Ingelheim, and Bristol-Myers Squibb. Dr. Christiansen has received unrestricted research grants from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 11, 2015.
- Revision received November 4, 2015.
- Accepted November 10, 2015.
- 2017 American College of Cardiology Foundation