Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.
Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.
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DOI：
10.1093/eurheartj/ehy530
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发表时间：
2018-11-01
影响因子：
39.3
通讯作者：
Patel MR
中科院分区：
文献类型：
--
作者：
Fairbairn TA;Nieman K;Akasaka T;Nørgaard BL;Berman DS;Raff G;Hurwitz-Koweek LM;Pontone G;Kawasaki T;Sand NP;Jensen JM;Amano T;Poon M;Øvrehus K;Sonck J;Rabbat M;Mullen S;De Bruyne B;Rogers C;Matsuo H;Bax JJ;Leipsic J;Patel MR
稳定性胸痛患者的无创评估是资源利用和临床结局的关键决定因素。越来越多的冠状动脉计算机断层扫描血管造影术（CCTA）与选择性CTA衍生的血流储备分数（FFRCT）正在使用。ADVANCE登记研究是一项在现实环境中使用CCTA和FFRCT诊断途径的大型前瞻性研究，旨在确定该途径对决策、下游有创冠状动脉造影（伊卡）、血运重建和主要不良心血管事件（MACE）的影响。2015年7月15日至2017年10月20日，在38家国际研究中心共入组了5083例CCTA显示有冠状动脉疾病（CAD）和动脉粥样硬化相关症状的患者。记录人口统计学、症状状态、CCTA和FFRCT结果、治疗计划和90天结局。66.9% [置信区间（CI）：64.8-67.6]的患者发生了核心实验室CCTA单独治疗与CCTA+基于FFRCT的管理计划之间重新分类的主要终点。与FFRCT> 0.80的患者相比，FFRCT ≤ 0.80的伊卡患者（14.4%）的非阻塞性冠状动脉疾病显著降低（43.8%，比值比0.19，CI：0.15-0.25，P < 0.001）。总体而言，72.3%接受伊卡且FFRCT ≤0.80的受试者接受了血运重建。FFRCT >0.80的患者90天内无死亡/心肌梗死（MI）发生（n = 1529），而19在FFRCT ≤0.80的受试者中发生了14例（0.6%）MACE [风险比（HR）19.75，CI：1.19-326，P = 0.0008]和14例（0.3%）死亡/MI（HR 14.68，CI 0.88-246，P = 0.039）。在大型国际多中心人群中，与单独CCTA相比，FFRCT修改了三分之二受试者的治疗建议，伊卡阴性较少，预测了血运重建，并确定了90天内不良事件风险较低的受试者。
Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). A total of 5083 patients with symptoms concerning for coronary artery disease (CAD) and atherosclerosis on CCTA were enrolled at 38 international sites from 15 July 2015 to 20 October 2017. Demographics, symptom status, CCTA and FFRCT findings, treatment plans, and 90 days outcomes were recorded. The primary endpoint of reclassification between core lab CCTA alone and CCTA plus FFRCT-based management plans occurred in 66.9% [confidence interval (CI): 64.8–67.6] of patients. Non-obstructive coronary disease was significantly lower in ICA patients with FFRCT ≤0.80 (14.4%) compared to patients with FFRCT >0.80 (43.8%, odds ratio 0.19, CI: 0.15–0.25, P < 0.001). In total, 72.3% of subjects undergoing ICA with FFRCT ≤0.80 were revascularized. No death/myocardial infarction (MI) occurred within 90 days in patients with FFRCT >0.80 (n = 1529), whereas 19 (0.6%) MACE [hazard ratio (HR) 19.75, CI: 1.19–326, P = 0.0008] and 14 (0.3%) death/MI (HR 14.68, CI 0.88–246, P = 0.039) occurred in subjects with an FFRCT ≤0.80. In a large international multicentre population, FFRCT modified treatment recommendation in two-thirds of subjects as compared to CCTA alone, was associated with less negative ICA, predicted revascularization, and identified subjects at low risk of adverse events through 90 days.
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影响因子：
24
作者：
Shaw, Leslee J.;Hausleiter, Joerg;Min, James K.
通讯作者：
Min, James K.
影响因子：
24
作者：
Norgaard, Bjarne L.;Leipsic, Jonathon;Achenbach, Stephan
通讯作者：
Achenbach, Stephan
影响因子：
168.9
作者：
Newby, David;Williams, Michelle;Steedman, Tracey
通讯作者：
Steedman, Tracey
影响因子：
39.3
作者：
Kang, Do-Yoon;Ahn, Jung-Min;Park, Seung-Jung
通讯作者：
Park, Seung-Jung
DOI：
10.1093/ehjci/jex068
发表时间：
2018-04-01
期刊：
European heart journal. Cardiovascular Imaging
影响因子：
--
作者：
Jensen JM;Bøtker HE;Mathiassen ON;Grove EL;Øvrehus KA;Pedersen KB;Terkelsen CJ;Christiansen EH;Maeng M;Leipsic J;Kaltoft A;Jakobsen L;Sørensen JT;Thim T;Kristensen SD;Krusell LR;Nørgaard BL
通讯作者：
Nørgaard BL