Fractional flow reserve by computerized tomography and subsequent coronary revascularization
Fractional flow reserve by computerized tomography and subsequent coronary revascularization
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DOI：
10.1093/ehjci/jew148
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发表时间：
2017-02-01
影响因子：
6.2
通讯作者：
Karlsberg, Ronald P.
中科院分区：
文献类型：
--
作者：
Packard, Rene R. Sevag;Li, Dong;Karlsberg, Ronald P.
目的 计算机断层扫描 (FFR-CT) 血流储备分数为冠状动脉狭窄的血流动力学意义提供非侵入性功能评估。我们确定了 FFR-CT 值、受试者操作特征 (ROC) 曲线以及 FFR-CT 对实际护理标准引导冠状动脉血运重建的预测能力。 方法和结果 确定了 2012 年至 2014 年 24 个月期间连续接受冠状动脉 CT 血管造影（冠状动脉 CTA）和侵入性血管造影的门诊患者。符合纳入标准的研究（n = 75 名患者，平均年龄 66 岁，75% 为男性）被送去进行 FFR-CT 分析，并根据冠状动脉钙 (CAC) 评分对结果进行分层。以盲法重新解读冠状动脉 CTA 研究，并回顾性获得基线 FFR-CT 值。因此，结果不会干扰临床决策。进行血运重建的冠状动脉 (n = 69) 的中位 FFR-CT 值为 0.70，未进行血运重建的冠状动脉 (n = 138) 的中位 FFR-CT 值为 0.86 (P < 0.001)。使用临床确定的 FFR-CT = 70% 狭窄的显着性临界值来预测临床决策和随后的冠状动脉血运重建，阳性预测值分别为 74% 和 88%，阴性预测值分别为 96% 和 84%。所有研究区域的曲线下面积 (AUC) 冠状动脉 CTA 为 0.904，FFR-CT 为 0.920，冠状动脉 CTA 联合 FFR-CT 为 0.941（P = 0.001）。随着 CAC 评分的增加，冠状动脉 CTA 的 AUC 下降，但 FFR-CT 的 AUC 仍然较高（P < 0.05）。 结论 添加 FFR-CT 为冠状动脉 CTA 提供了补充作用，并提高了基于 CT 的方法确定后续护理标准引导冠状动脉血运重建的能力。
Aims 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 actual standard of care guided coronary revascularization.Methods and results 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 (n = 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 (n = 69) and 0.86 in not revascularized (n = 138) coronary arteries (P < 0.001). Using clinically established significance cut-offs of FFR-CT = 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 (P = 0.001). With increasing CAC scores, the AUC decreased for coronary CTA but remained higher for FFR-CT (P < 0.05).Conclusion 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.