Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial

Maros Ferencik; Michael T Lu; Thomas Mayrhofer; Stefan B Puchner; Ting Liu; Pal Maurovich-Horvat; Khristine Ghemigian; Alexander Ivanov; Elizabeth Adami; John T Nagurney; Pamela K Woodard; Quynh A Truong; James E Udelson; Udo Hoffmann

doi:10.1016/j.jcct.2019.05.009

Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial

J Cardiovasc Comput Tomogr. 2019 Jul-Aug;13(4):196-202. doi: 10.1016/j.jcct.2019.05.009. Epub 2019 May 15.

Authors

Affiliations

¹ Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: ferencik@ohsu.edu.
² Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany.
⁴ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
⁵ Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China.
⁶ MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
⁷ Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
⁹ Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
¹⁰ Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA.

Abstract

Background: Non-invasive fractional flow reserve (FFR_CT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFR_CT in the population of acute chest pain patients and assessed the relationship of FFR_CT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics.

Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFR_CT was measured in a core laboratory.

Results: We found correlation between anatomic severity of stenosis and FFR_CT ≤0.80 vs. FFR_CT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFR_CT values (median 0.64, 25th-75th percentile 0.50-0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78-0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFR_CT ≤0.80 was 4.03 (95% CI 1.56-10.36) and 3.50 (95% CI 1.12-10.96), respectively. FFR_CT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55-9.85, p = 0.004) after adjustment for stenosis severity.

Conclusion: Abnormal FFR_CT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFR_CT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.

Keywords: Acute coronary syndrome; Coronary computed tomography angiography; Non-invasive cardiac testing; Non-invasive fractional flow reserve; Risk stratification; Stress test.

MeSH terms

Acute Coronary Syndrome / diagnostic imaging*
Acute Coronary Syndrome / physiopathology
Acute Coronary Syndrome / therapy
Angina Pectoris / diagnostic imaging*
Angina Pectoris / physiopathology
Angina Pectoris / therapy
Computed Tomography Angiography*
Coronary Angiography / methods*
Coronary Stenosis / diagnostic imaging*
Coronary Stenosis / physiopathology
Coronary Stenosis / therapy
Feasibility Studies
Female
Fractional Flow Reserve, Myocardial*
Humans
Male
Middle Aged
Myocardial Revascularization
Predictive Value of Tests
Prognosis
Randomized Controlled Trials as Topic
Severity of Illness Index

Abstract

MeSH terms

Grants and funding