Completeness of revascularization by FFRCT in stable angina: Association to adverse cardiovascular outcomes

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Computed Tomography Pub Date : 2024-09-01 DOI:10.1016/j.jcct.2024.07.007

Kristian Tækker Madsen , Bjarne Linde Nørgaard , Kristian Altern Øvrehus , Jesper Møller Jensen , Erik Parner , Erik Lerkevang Grove , Martin B. Mortensen , Nadia Iraqi , Timothy A. Fairbairn , Koen Nieman , Manesh R. Patel , Campbell Rogers , Sarah Mullen , Hans Mickley , Kristian Korsgaard Thomsen , Hans Erik Bøtker , Jonathon Leipsic , Niels Peter Rønnow Sand

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Abstract

Background

The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.

Objectives

To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR_CT) and cardiovascular outcomes in patients with stable angina.

Methods

Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR_CT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR_CT ≤ 0.80 were categorized as: Completely revascularized (CR-FFR_CT), all vessels with FFR_CT ≤ 0.80 revascularized; incompletely revascularized (IR-FFR_CT), ≥ 1 vessels with FFR_CT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.

Results

Amongst 900 patients and 1759 vessels, FFR_CT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR_CT (15/210 [7.1%]) compared to CR-FFR_CT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01–8.8, p = 0.036, and to normal FFR_CT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6–42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFR_CT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFR_CT ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFR_CT > 0.80 (10/1223 [0.8%]), p < 0.001.

Conclusion

Incomplete revascularization of patients with lesion-specific FFR_CT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFR_CT > 0.80.

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稳定型心绞痛患者的 FFRCT 血管再通完整性：与不良心血管后果的关系

背景：完全冠状动脉血运重建相对于无创检测方法的预后影响尚不清楚：相对于无创检测方法，完全冠状动脉血运重建对预后的影响尚不清楚：评估稳定型心绞痛患者中由 CTA 导出的分数血流储备（FFRCT）定义的血管再通完整性与心血管预后之间的关联：对新发稳定型心绞痛患者进行为期 3 年的多中心随访研究。对所有血管狭窄的病变特异性 FFRCT 值（两厘米远端至狭窄处）进行登记，当值≤0.80 时视为异常。FFRCT ≤ 0.80 的患者被归类为完全血管再通（CR-FFRCT），FFRCT ≤ 0.80 的所有血管均再通；不完全血管再通（IR-FFRCT），FFRCT ≤ 0.80 的≥ 1 根血管未再通。早期血管再通（距索引 CTA < 90 天）的血管归类为血管再通。主要终点包括心血管死亡和非致死性心肌梗死；次要终点为血管特异性晚期血管再通和非致死性心肌梗死：在900名患者和1759条血管中，377名患者（42%）和536条血管（30%）的FFRCT≤0.80；244名患者（27%）和340条血管（19%）进行了血管重建。与CR-FFRCT（4/167 [2.4%]）相比，IR-FFRCT（15/210 [7.1%]）的主要终点风险更高，RR：2.98；95% CI：1.01-8.8，p = 0.036；与正常FFRCT（3/523 [0.6%]）相比，RR：12.45; 95% CI: 3.6-42.6, p CT ≤ 0.80 (29/250 [12%])与 FFRCT ≤ 0.80 (5/286 [1.7%])的血管再通相比，P = 0.001，与 FFRCT > 0.80 (10/1223 [0.8%])的血管相比，P 结论：与血管完全再通或 FFRCT > 0.80 的患者相比，病变特异性 FFRCT ≤ 0.80 的患者血管再通不完全与不利的心血管预后有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Computed Tomography CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.50

自引率

14.80%

发文量

212

审稿时长

40 days

期刊介绍： The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.