Does the Routine Availability of CT-Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?: The FFRCT RIPCORD Study

Nicholas P Curzen; James Nolan; Azfar G Zaman; Bjarne L Nørgaard; Ronak Rajani

doi:10.1016/j.jcmg.2015.12.026

Does the Routine Availability of CT-Derived FFR Influence Management of Patients With Stable Chest Pain Compared to CT Angiography Alone?: The FFR_CT RIPCORD Study

JACC Cardiovasc Imaging. 2016 Oct;9(10):1188-1194. doi: 10.1016/j.jcmg.2015.12.026. Epub 2016 Aug 24.

Authors

Nicholas P Curzen¹, James Nolan², Azfar G Zaman³, Bjarne L Nørgaard⁴, Ronak Rajani⁵

Affiliations

¹ University Hospital Southampton & Faculty of Medicine, University of Southampton, Southampton, United Kingdom. Electronic address: nick.curzen@uhs.nhs.uk.
² University Hospitals of North Staffordshire, Stoke-on-Trent, United Kingdom.
³ Freeman Hospital, and Institute of Cellular Medicine Newcastle University, Newcastle upon Tyne, United Kingdom.
⁴ Aarhus University Hospital Skejby, Aarhus, Denmark.
⁵ Guy's & St. Thomas' Hospital, London, United Kingdom.

PMID: 27568119
DOI: 10.1016/j.jcmg.2015.12.026

Abstract

Objectives: This study sought to determine the effect of adding computed tomography-derived fractional flow reserve (FFR_CT) data to computed tomography angiographic (CTA) data alone for assessment of lesion severity and patient management in 200 patients with chest pain.

Background: Invasive and noninvasive tests used in the assessment of patients with angina all have disadvantages. The ideal screening test for patients presenting for the first time with chest pain would describe both coronary anatomy and the presence of ischemia and would be readily accessible, low cost, and noninvasive.

Methods: Two hundred patients with stable chest pain underwent CTA for clinical reasons, and FFR_CT was calculated. Three experienced interventional cardiologists assessed the CTA result for each patient and by consensus developed a management plan (optimal medical therapy, percutaneous coronary intervention, coronary artery bypass graft surgery, or more information required). FFR_CT data for each vessel were then revealed, and the interventional cardiologists made a second plan by consensus, using the same 4 options. The primary endpoint for the study was the difference between the 2 strategies.

Results: Overall, after disclosure of FFR_CT data there was a change in the allocated management category on the basis of CTA alone in 72 cases (36%). This difference is explained by a discordance between the CTA- and FFR_CT-derived assessments of lesion severity. For example, FFR_CT was >0.80 in 13 of 44 vessels (29.5%) graded as having a stenosis >90%. In contrast, FFR_CT was ≤0.80 in 17 of 366 vessels (4.6%) graded as having stenosis ≤50%.

Conclusions: This study demonstrates proof of concept that the availability of FFR_CT results has a substantial effect on the labeling of significant coronary artery disease and therefore on the management of patients compared to CTA alone. Further studies are needed to determine whether FFR_CT has potential as a noninvasive diagnostic and management screening tool for patients with stable chest pain.

Keywords: chest pain; computed tomography angiography; computed tomography–derived fractional flow reserve.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Angina, Stable / diagnostic imaging*
Angina, Stable / etiology
Angina, Stable / physiopathology
Angina, Stable / therapy
Computed Tomography Angiography*
Coronary Angiography / methods*
Coronary Artery Disease / complications
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / physiopathology
Coronary Artery Disease / therapy
Coronary Vessels / diagnostic imaging*
Coronary Vessels / physiopathology
Fractional Flow Reserve, Myocardial*
Humans
Predictive Value of Tests
Prognosis
Severity of Illness Index