P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Alashi ◽  
E Huttcenteno ◽  
P Schoenhagen ◽  
Z B Popovic ◽  
P Cremer ◽  
...  
Keyword(s):  
High Risk ◽  
Prognostic Value ◽  
Coronary Revascularization ◽  
Coronary Plaque ◽  
Suspected Coronary Artery Disease ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Prognostic Utility ◽  
Composite Events

Abstract Background In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood. Aims We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA. Methods We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded. Results 188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively. Conclusion In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.

P6186Symptomatic effect of coronary revascularization at 1-year follow-up in stable chest pain - prediction by coronary computed tomography angiography derived fractional flow reserve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K T Madsen ◽  
B L Noergaard ◽  
K T Veien ◽  
P Larsen ◽  
M Husain ◽  
...  
Keyword(s):  
Chest Pain ◽  
Fractional Flow Reserve ◽  
Coronary Revascularization ◽  
Symptomatic Relief ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Coronary Ct ◽  
Flow Reserve ◽  
Stable Chest Pain

Abstract Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFRct) is increasingly being used for guiding referral to invasive procedures in patients with stable chest pain. However, the ability of FFRct to predict the symptomatic effect of revascularization remains unclear. Purpose To evaluate the ability of different vessel-specific physiological FFRct derived measures of ischemia for predicting the occurrence of chest pain one year after coronary revascularization in stable patients. Methods Retrospective study in patients with stable chest pain referred for coronary angiography based on coronary CTA. Standard acquired coronary CTA data sets were transmitted for core-laboratory analysis at HeartFlow. Patients were categorized as positive for ischemia using 3 different algorithms: Lowest in vessel FFRct-value ≤0.80; ΔFFRct ≥0.06 or a combination of the two. Personnel responsible for downstream patient management had no information on FFRct test results. Classification of revascularization was performed based on the applied FFRct algorithm: complete if all FFRct positive lesions were revascularized; incomplete if ≥1 FFRct positive lesion was not revascularized. Symptomatic status at 1-year follow-up was obtained by a visit in the outpatient clinic or by telephone. Results A total of 172 patients were included. Revascularization was performed in 62 (35%) patients. At 1-year follow-up 48 (28%) patients had chest pain; 15 (24%) revascularized vs 33 (30%) non-vascularized patients, p=0.415. No difference in utilization of anti-anginal medicine for patients with and without chest pain was registered at 1-year follow-up. The association between the chosen FFRct algorithm, revascularization and occurrence of chest pain at 1-year follow-up are shown in the Table. FFRct, Revascularization and Chest pain FFRCT, Algorithm Revascularizationb Patients with chest pain 1-year risk of chest pain p-valuec N (%) OR (95%-CI) Distal FFRCT ≤0.80 Incomplete 32 (34) Ref. Distal FFRCT ≤0.80 Complete 4 (15) 0.34 (0.11, 1.06) Distal FFRCT >0.80 No 11 (24) 0.61 (0.27, 1.35) 0.097 ΔFFRCT ≥0.06 Incomplete 34 (35) Ref. ΔFFRCT ≥0.06 Complete 7 (21) 0.49 (0.19, 1.24) ΔFFRCT <0.06 No 7 (18) 0.41 (0.16, 1.03) 0.074 Combinationa abnormal Incomplete 30 (40) Ref. Combination abnormal Complete 6 (18) 0.32 (0.12, 0.87) Combination normal No 11 (19) 0.35 (0.16, 0.78) 0.009 aDistal FFRCT ≤0.80 and ΔFFRCT ≥0.06. bIncomplete (≥1 FFRCT positive lesion not revascularized); complete (All FFRCT positive lesions revascularized); No (No FFRCT positive lesions and revascularization not performed). cBetween group comparison performed using logistic regression. Conclusion Revascularization based on classification by FFRct is associated with symptomatic relief at 1-year follow-up in patients with stable chest pain.

scholarly journals Prognostic value of regional myocardial flow reserve derived from 13N-ammonia positron emission tomography in patients with suspected coronary artery disease

2021 ◽  
Author(s):  
Elia von Felten ◽  
Dominik C. Benz ◽  
Georgios Benetos ◽  
Jessica Baehler ◽  
Dimitri Patriki ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Prognostic Value ◽  
Suspected Coronary Artery Disease ◽  
Emission Tomography ◽  
Flow Reserve ◽  
Positron Emission ◽  
Artery Disease ◽  
Myocardial Flow ◽  
Group 1

Abstract Purpose To assess the prognostic value of regional quantitative myocardial flow measures as assessed by 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) in patients with suspected coronary artery disease (CAD). Methods We retrospectively included 150 consecutive patients with suspected CAD who underwent clinically indicated 13 N-ammonia PET-MPI and who did not undergo revascularization within 90 days of PET-MPI. The presence or absence of a decreased global myocardial flow reserve (i.e., MFR < 2) as well as decreased regional MFR (i.e., ≥ 2 adjacent segments with MFR < 2) was recorded, and patients were classified as having preserved global and regional MFR (MFR group 1), preserved global but decreased regional MFR (MFR group 2), or decreased global and regional MFR (MFR group 3). We obtained follow-up regarding major adverse cardiac events (MACE, i.e., a combined endpoint including all-cause death, non-fatal myocardial infarction, and late revascularization) and all-cause death. Results Over a median follow-up of 50 months (IQR 38–103), 30 events occurred in 29 patients. Kaplan–Meier analysis showed significantly reduced event-free and overall survival in MFR groups 2 and 3 compared to MFR group 1 (log-rank: p = 0.015 and p = 0.013). In a multivariable Cox regression analysis, decreased regional MFR was an independent predictor for MACE (adjusted HR 3.44, 95% CI 1.17–10.11, p = 0.024) and all-cause death (adjusted HR 4.72, 95% CI 1.07–20.7, p = 0.04). Conclusions A decreased regional MFR as assessed by 13 N-ammonia PET-MPI confers prognostic value by identifying patients at increased risk for future adverse cardiac outcomes and all-cause death.

Abstract 3334: Comparison of Medical Treatment and Coronary Revascularization in Patients with Moderate Coronary Lesions and Borderline Fractional Flow Reserve Measurements

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Javier Courtis ◽  
Olivier F Bertrand ◽  
Eric Larose ◽  
Can M Nguyen ◽  
Jean-Pierre Déry ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Treatment ◽  
Fractional Flow Reserve ◽  
Coronary Revascularization ◽  
Previous Myocardial Infarction ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

Background. There is little information available regarding deferral of revascularization in cases of fractional flow reserve (FFR) measurements in the borderline range (between 0.75 to 0.80). The objectives of this study were to evaluate the clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80, comparing those who underwent coronary revascularization (CR) to those who had medical treatment (MT), and to determine the predictive factors of major adverse cardiac events (MACE) at follow-up. Methods. A total of 107 consecutive patients (mean age 62 ± 10 years) with at least one moderate coronary lesion (mean percent diameter stenosis 47 ± 12%) evaluated by coronary pressure wire with FFR measurement between 0.75 and 0.80 (mean 0.77 ± 0.02) were included in the study. Maximal hyperemia was obtained by intracoronary administration of adenosine (mean dose 215 ± 84 μg). MACE (coronary revascularization, myocardial infarction, cardiac death) and the presence of angina were evaluated at follow-up. Results. A total of 63 patients (59%) underwent CR and 44 patients (41%) had MT, with no clinical differences between groups. At a mean follow-up of 13 ± 7 months, MACE related to the coronary lesion evaluated by FFR were higher in the MT group compared to CR group (23% vs 5%, difference 18%, 95% CI 5%–30%, p=0.005). FFR measurement in an artery supplying a territory with previous myocardial infarction was the only predictive factor of MACE in the MT group (odds ratio 14.1, 95% CI 1.3–39, p=0.03). The presence of angina at follow-up was more frequent in the MT group compared to the CR group (41% vs 9%, difference 32%, 95% CI 11%–49%, p<0.001). Conclusions. In patients with moderate coronary lesions and FFR measurements in the “grey zone” range deferral of revascularization was associated with a higher rate of cardiac events and a higher prevalence of angina at follow-up, especially in those with previous myocardial infarction in the territory evaluated by FFR. These results suggest that a FFR cut-off point of 0.80 rather than 0.75 might be more appropriate for deferring coronary revascularization in these cases.

Abstract 911: Usefulness of Coronary Fractional Flow Reserve Measurements to Guide Clinical Decisions in Intermediate Left Main Coronary Stenoses. Results of a Study Including 142 Consecutive Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Josep Rodès-Cabau ◽  
Javier Courtis ◽  
Jean-Michel Potvin ◽  
Melanie Côté ◽  
Jean-Pierre Dery ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Medical Treatment ◽  
Cardiac Death ◽  
Coronary Revascularization ◽  
Clinical Decisions ◽  
Left Main ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Flow Reserve

Background: Limited data exist on the use of fractional flow reserve (FFR) measurements to guide clinical decisions in patients with intermediate left main coronary artery (LMCA) stenosis. Objectives: To evaluate the usefulness of FFR measurements to guide the clinical decision in patients with intermediate LMCA stenosis and to determine the predictors of major adverse cardiac events [MACE] (cardiac death, myocardial infarction, coronary revascularization) in such cases. Methods: A total of 142 consecutive patients (mean age 62 ± 10 yrs) with intermediate LMCA stenosis (mean percent diameter stenosis 42 ± 13%) were included. All patients underwent FFR measurement after intracoronary (ic) administration of adenosine at a dose ≥30 μg. Special care was taken in cases with ostial lesions to pull the catheter out of the LMCA after adenosine administration. The clinical decisions were based on FFR as follows: coronary revascularization was recommended if FFR was <0.75, medical treatment if FFR was >0.80, and individualized decision based on additional clinical data if FFR was between 0.75 and 0.80. The occurrence of MACE was evaluated at 14 ± 11 months follow-up. Results: Mean FFR was 0.81 ± 0.09 after the administration of a mean dose of 176 ± 99 μg of ic adenosine. Based on FFR results, sixty patients (42%) underwent coronary revascularization and 82 patients (58%) received medical treatment. At follow-up, the incidence of MACE related to the LMCA stenosis was 13% in the medical treatment group and 7% in the coronary revascularization group (p=0.27). The incidence of cardiac death and myocardial infarction was 7% in both groups (p=1.0). In the medical treatment group, patients with MACE had received a lower dose of ic adenosine (86 ± 57 μg vs. 167 ± 102 μg, OR: 1.39 for each decrease of 30 μg of ic adenosine, 95% CI 1.02–1.89, p=0.04) and were more frequently diabetics (55% vs. 21%, OR: 4.40, 95% CI 1.17–16.42, p=0.02). Conclusions: FFR measurement is helpful in guiding the decision as to whether to revascularize patients with intermediate LMCA stenosis. However, diabetic patients remain at higher risk, and higher doses than previously recommended of ic adenosine should be used in the evaluation of LMCA to avoid cardiac events due to underestimation of stenosis severity.

P3652Hemodynamic and clinical impact of ANOmalous connections of CORonary arteries using computed tomography-derived Fractional Flow Reserve (FFRCT) from the ANOCOR registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Adjedj ◽  
F H Hyafil ◽  
W F Ferrag ◽  
R F Farnoud ◽  
O M Muller ◽  
...  
Keyword(s):  
Computed Tomography ◽  
At Risk ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Coronary Revascularization ◽  
Clinical Impact ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Background With the emergence of coronary computed tomography angiography (CCTA), ANOmalous connections of CORonary arteries (ANOCOR) are more frequently diagnosed than previously reported. CT-derived Fractional Flow Reserve (FFRCT) is a non-invasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features could help for the management of patients with ANOCOR. Objective We aimed to retrospectively evaluate the clinical impact of FFRCT analysis in the ANOCOR registry population with 3 year-follow-up. Method The ANOCOR registry included adult patients with ANOCOR detected during invasive coronary angiogram or CCTA performed between January 2010 and January 2013. Among 472 patients included, 105 patients had a cardiac CT during the inclusion period. Results We retrospectively performed FFR-CT and obtained successful analyses in 54 patients of 60±13 years with a complete 3-year clinical follow-up. Thirty-six (67%) patients had conservative treatment and 18 (33%) patients had coronary revascularization after the CCTA. FFRCT analysis showed that ANOCOR course slightly reduces the mean FFRCT value of 1 at the ostium to 0.90±0.10 downstream the abnormal course and had a distal vessel mean FFRCT value 0.82±0.11. No statistical difference of FFRCT values were observed between ANOCOR at risk and non at risk and between conservative and revascularization groups. At 3 years of follow-up, only one patient had unplanned revascularizations of ANOCOR vessel in the conservative strategy group. Conclusion We observed favorable FFRCT values of ANOCOR and non ANOCR vessels. Patients treated conservatively and revascularized had excellent clinical outcome at 3 years of follow up.

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