Fractional flow reserve by computerized tomography and subsequent coronary revascularization

<span class="paragraphSection"><div class="boxTitle">Aims</div>Fractional flow reserve by computerized tomography (FFR-CT) provides non-invasive functional assessment of the hemodynamic significance of coronary artery stenosis. We determined the FFR-CT values, receiver operator characteristic (ROC) curves, and predictive ability of FFR-CT for <span style="font-style:italic;">actual</span> standard of care guided coronary revascularization.<div class="boxTitle">Methods and results</div>Consecutive outpatients who underwent coronary CT angiography (coronary CTA) followed by invasive angiography over a 24-month period from 2012 to 2014 were identified. Studies that fit inclusion criteria (<span style="font-style:italic;">n</span> = 75 patients, mean age 66, 75% males) were sent for FFR-CT analysis, and results stratified by coronary artery calcium (CAC) scores. Coronary CTA studies were re-interpreted in a blinded manner, and baseline FFR-CT values were obtained retrospectively. Therefore, results did not interfere with clinical decision-making. Median FFR-CT values were 0.70 in revascularized (<span style="font-style:italic;">n</span> = 69) and 0.86 in not revascularized (<span style="font-style:italic;">n</span> = 138) coronary arteries (<span style="font-style:italic;">P</span> < 0.001). Using clinically established significance cut-offs of FFR-CT ≤0.80 and coronary CTA ≥70% stenosis for the prediction of clinical decision-making and subsequent coronary revascularization, the positive predictive values were 74 and 88% and negative predictive values were 96 and 84%, respectively. The area under the curve (AUC) for all studied territories was 0.904 for coronary CTA, 0.920 for FFR-CT, and 0.941 for coronary CTA combined with FFR-CT (<span style="font-style:italic;">P</span> = 0.001). With increasing CAC scores, the AUC decreased for coronary CTA but remained higher for FFR-CT (<span style="font-style:italic;">P</span> < 0.05).<div class="boxTitle">Conclusion</div>The addition of FFR-CT provides a complementary role to coronary CTA and increases the ability of a CT-based approach to identify subsequent standard of care guided coronary revascularization.</span>

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