Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial.
Noninvasive FFR Derived From Coronary CT Angiography: Management and Outcomes in the PROMISE Trial.
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DOI：
10.1016/j.jcmg.2016.11.024
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Hoffmann U
中科院分区：
文献类型：
--
作者：
Lu MT;Ferencik M;Roberts RS;Lee KL;Ivanov A;Adami E;Mark DB;Jaffer FA;Leipsic JA;Douglas PS;Hoffmann U
确定计算机断层扫描（FFRCT）得出的无创血流储备分数是否可预测冠状动脉血运重建和结局，以及增加FFRCT是否可提高冠状动脉CT血管造影（CTA）后转诊至有创冠状动脉血管造影（伊卡）的效率。FFRCT可提高解剖CTA策略治疗稳定性胸痛的效率。PROMISE试验入组的稳定性胸痛患者的观察性队列研究在CTA后90天内转诊至伊卡。在设盲的核心实验室测量FFRCT，护理人员无法获得FFRCT结果。我们确定了FFRCT（阳性，如果≤0.80）与CTA和伊卡狭窄（阳性，如果≥50%左主干或≥70%其他冠状动脉）的一致性，以及冠状动脉血运重建或MACE（死亡、心肌梗死或不稳定型心绞痛）复合终点的预测值。我们回顾性评估了增加FFRCT ≤0.80作为守门人是否可以提高转介至伊卡的效率，定义为无≥50%狭窄的伊卡率降低和导致血运重建的伊卡发生率增加。在67%（181/271）的合格患者（平均年龄62岁，36%为女性）中计算了FFRCT。对于CTA和伊卡，分别有31%（57/181）和29%（52/181）的FFRCT与狭窄不一致。大多数接受冠状动脉血运重建的患者的FFRCT ≤0.80（91%，80/88）。FFRCT ≤0.80是比重度CTA狭窄更好的血运重建或MACE预测因子（HR 4.3 [95% CI 2.4-8.9] vs. 2.9 [1.8-5.1]; p=0.033）。对于FFRCT ≤0.80的患者，保留伊卡可使无≥50%狭窄的伊卡减少44%，并使伊卡导致血运重建的比例增加24%。在这项基于CTA转诊至伊卡的稳定性胸痛患者的假设生成研究中，FFRCT ≤0.80是比CTA重度狭窄更好的血运重建或MACE预测因子。增加FFRCT可提高从单独CTA转诊至伊卡的效率。
To determine whether noninvasive fractional flow reserve derived from computed tomography (FFRCT) predicts coronary revascularization and outcomes and whether its addition improves efficiency of referral to invasive coronary angiography (ICA) after coronary CT angiography (CTA). FFRCT may improve the efficiency of an anatomic CTA strategy for stable chest pain. Observational cohort study of patients with stable chest pain enrolled in the PROMISE trial referred to ICA within 90 days after CTA. FFRCT was measured at a blinded core lab, and FFRCT results were unavailable to caregivers. We determined the agreement of FFRCT (positive if ≤0.80) with stenosis on CTA and ICA (positive if ≥50% left main or ≥70% other coronary artery), and predictive value for a composite of coronary revascularization or MACE (death, myocardial infarction, or unstable angina). We retrospectively assessed whether adding FFRCT ≤0.80 as a gatekeeper could improve efficiency of referral to ICA, defined as decreased rate of ICA without ≥50% stenosis and increased ICA leading to revascularization. FFRCT was calculated in 67% (181/271) of eligible patients (mean age 62 years, 36% women). FFRCT was discordant with stenosis in 31% (57/181) for CTA and 29% (52/181) for ICA. Most patients undergoing coronary revascularization had FFRCT ≤0.80 (91%, 80/88). FFRCT ≤0.80 was a significantly better predictor for revascularization or MACE than severe CTA stenosis (HR 4.3 [95% CI 2.4–8.9] versus 2.9 [1.8–5.1]; p=0.033). Reserving ICA for patients with FFRCT ≤0.80 could decrease ICA without ≥50% stenosis by 44%, and increase the proportion of ICA leading to revascularization by 24%. In this hypothesis-generating study of patients with stable chest pain referred to ICA from CTA, FFRCT ≤0.80 was a better predictor of revascularization or MACE than severe stenosis on CTA. Adding FFRCT may improve efficiency of referral to ICA from CTA alone.
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影响因子：
24
作者：
Fihn, Stephan D.;Gardin, Julius M.;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.
影响因子：
24
作者：
Norgaard, Bjarne L.;Leipsic, Jonathon;Achenbach, Stephan
通讯作者：
Achenbach, Stephan
影响因子：
39.3
作者：
Douglas PS;Pontone G;Hlatky MA;Patel MR;Norgaard BL;Byrne RA;Curzen N;Purcell I;Gutberlet M;Rioufol G;Hink U;Schuchlenz HW;Feuchtner G;Gilard M;Andreini D;Jensen JM;Hadamitzky M;Chiswell K;Cyr D;Wilk A;Wang F;Rogers C;De Bruyne B;PLATFORM Investigators
通讯作者：
PLATFORM Investigators
冠状动脉断层扫描血管造影的舌下硝酸甘油给药：系统评价。
影响因子：
5.9
作者：
Takx RA;Suchá D;Park J;Leiner T;Hoffmann U
通讯作者：
Hoffmann U
影响因子：
24
作者：
Tonino, Pim A. L.;Fearon, William F.;Pijls, Nico H. J.
通讯作者：
Pijls, Nico H. J.