Author + information
- Received December 3, 2018
- Revision received April 30, 2019
- Accepted May 8, 2019
- Published online July 17, 2019.
- Kavitha M. Chinnaiyan, MD∗ (, )@ChinnaiyanMD,
- Robert D. Safian, MD,
- Michael L. Gallagher, MD,
- Julie George, MS,
- Simon R. Dixon, MBChB,
- Abhay N. Bilolikar, MD,
- Amr E. Abbas, MD,
- Mazen Shoukfeh, MD,
- Marc Brodsky, MD,
- James Stewart, MD,
- Elvis Cami, MD,
- David Forst, MD,
- Steven Timmis, MD,
- Jason Crile, MD and
- Gilbert L. Raff, MD
- ↵∗Address for correspondence:
Dr. Kavitha M. Chinnaiyan, Beaumont Health, 3601 West 13 Mile Road, Royal Oak, Michigan 48073.
Objectives The study sought to examine the feasibility, safety, clinical outcomes, and costs associated with computed tomography–derived fractional flow reserve (FFRCT) in acute chest pain (ACP) patients in a coronary computed tomography angiography (CTA)–based triage program.
Background FFRCT is useful in determining lesion-specific ischemia in patients with stable ischemic heart disease, but its utility in ACP has not been studied.
Methods ACP patients with no known coronary artery disease undergoing coronary CTA and coronary CTA with FFRCT were studied. FFRCT ≤0.80 was considered positive for hemodynamically significant stenosis.
Results Among 555 patients, 297 underwent coronary CTA and FFRCT (196 negative, 101 positive), whereas 258 had coronary CTA only. The rejection rate for FFRCT was 1.6%. At 90 days, there was no difference in major adverse cardiac events (including death, nonfatal myocardial infarction, and unexpected revascularization after the index visit) between the coronary CTA and FFRCT groups (4.3% vs. 2.7%; p = 0.310). Diagnostic failure, defined as discordance between the coronary CTA or FFRCT results with invasive findings, did not differ between the groups (1.9% vs. 1.68%; p = NS). No deaths or myocardial infarction occurred with negative FFRCT when revascularization was deferred. Negative FFRCT was associated with higher nonobstructive disease on invasive coronary angiography (56.5%) than positive FFRCT (8.0%) and coronary CTA (22.9%) (p < 0.001). There was no difference in overall costs between the coronary CTA and FFRCT groups ($8,582 vs. $8,048; p = 0.550).
Conclusions In ACP, FFRCT is feasible, with no difference in major adverse cardiac events and costs compared with coronary CTA alone. Deferral of revascularization is safe with negative FFRCT, which is associated with higher nonobstructive disease on invasive angiography.
This study was supported by a grant from HeartFlow (Redwood City, California) to Beaumont Health. HeartFlow was not involved in the design or conduct of this study, analysis, or interpretation of data, in the preparation, review or approval of the manuscript. Drs. Chinnaiyan and Safian serve on the medical advisory board for and receive institutional research grant support from HeartFlow, Inc. Dr. Gallagher serves on the Speakers Bureau for HeartFlow, Inc. Dr. Raff has received research grant support from HeartFlow, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 3, 2018.
- Revision received April 30, 2019.
- Accepted May 8, 2019.
- 2019 American College of Cardiology Foundation
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