1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT: The ADVANCE Registry

Manesh R. Patel, Bjarne Linde Nørgaard, Timothy A. Fairbairn, Koen Nieman, Takashi Akasaka, Daniel S. Berman, Gilbert L. Raff, Lynne M. Hurwitz Koweek, Gianluca Pontone, Tomohiro Kawasaki, Niels Peter Rønnow Sand, Jesper M. Jensen, Tetsuya Amano, Michael Poon, Kristian A. Øvrehus, Jeroen Sonck, Mark G. Rabbat, Sarah Mullen, Bernard De Bruyne, Campbell RogersHitoshi Matsuo, Jeroen J. Bax, Jonathon Leipsic

Research output: Contribution to journalArticle

Abstract

Objectives: The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. Background: Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Methods: Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. Results: At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFRCT ≤0.80 and in 89 (5.60%) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFRCT ≤0.80 and 12 occurred in those with an FFRCT >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFRCT ≤0.80 compared with 10 (0.60%) patients with an FFRCT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT ≤0.80 compared with patients with an FFRCT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). Conclusions: The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679)

Original languageEnglish
Pages (from-to)97-105
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 2020

Fingerprint

Registries
Myocardial Infarction
Confidence Intervals
Acute Coronary Syndrome
Chest Pain
Coronary Artery Disease
Cause of Death
Atherosclerosis
Patient Care
Demography
Guidelines
Computed Tomography Angiography

Keywords

  • clinical outcomes
  • clinical practice
  • coronary computed tomography angiography
  • FFR
  • fractional flow reserve
  • major adverse cardiac events

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Patel, M. R., Nørgaard, B. L., Fairbairn, T. A., Nieman, K., Akasaka, T., Berman, D. S., ... Leipsic, J. (2020). 1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT: The ADVANCE Registry. JACC: Cardiovascular Imaging, 13(1), 97-105. https://doi.org/10.1016/j.jcmg.2019.03.003

1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT : The ADVANCE Registry. / Patel, Manesh R.; Nørgaard, Bjarne Linde; Fairbairn, Timothy A.; Nieman, Koen; Akasaka, Takashi; Berman, Daniel S.; Raff, Gilbert L.; Hurwitz Koweek, Lynne M.; Pontone, Gianluca; Kawasaki, Tomohiro; Sand, Niels Peter Rønnow; Jensen, Jesper M.; Amano, Tetsuya; Poon, Michael; Øvrehus, Kristian A.; Sonck, Jeroen; Rabbat, Mark G.; Mullen, Sarah; De Bruyne, Bernard; Rogers, Campbell; Matsuo, Hitoshi; Bax, Jeroen J.; Leipsic, Jonathon.

In: JACC: Cardiovascular Imaging, Vol. 13, No. 1, 01.2020, p. 97-105.

Research output: Contribution to journalArticle

Patel, MR, Nørgaard, BL, Fairbairn, TA, Nieman, K, Akasaka, T, Berman, DS, Raff, GL, Hurwitz Koweek, LM, Pontone, G, Kawasaki, T, Sand, NPR, Jensen, JM, Amano, T, Poon, M, Øvrehus, KA, Sonck, J, Rabbat, MG, Mullen, S, De Bruyne, B, Rogers, C, Matsuo, H, Bax, JJ & Leipsic, J 2020, '1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT: The ADVANCE Registry', JACC: Cardiovascular Imaging, vol. 13, no. 1, pp. 97-105. https://doi.org/10.1016/j.jcmg.2019.03.003
Patel, Manesh R. ; Nørgaard, Bjarne Linde ; Fairbairn, Timothy A. ; Nieman, Koen ; Akasaka, Takashi ; Berman, Daniel S. ; Raff, Gilbert L. ; Hurwitz Koweek, Lynne M. ; Pontone, Gianluca ; Kawasaki, Tomohiro ; Sand, Niels Peter Rønnow ; Jensen, Jesper M. ; Amano, Tetsuya ; Poon, Michael ; Øvrehus, Kristian A. ; Sonck, Jeroen ; Rabbat, Mark G. ; Mullen, Sarah ; De Bruyne, Bernard ; Rogers, Campbell ; Matsuo, Hitoshi ; Bax, Jeroen J. ; Leipsic, Jonathon. / 1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT : The ADVANCE Registry. In: JACC: Cardiovascular Imaging. 2020 ; Vol. 13, No. 1. pp. 97-105.
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abstract = "Objectives: The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. Background: Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Methods: Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. Results: At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40{\%}) patients with an FFRCT ≤0.80 and in 89 (5.60{\%}) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95{\%} confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFRCT ≤0.80 and 12 occurred in those with an FFRCT >0.80 (RR: 1.81; 95{\%} CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20{\%}) patients with an FFRCT ≤0.80 compared with 10 (0.60{\%}) patients with an FFRCT >0.80 (RR: 1.92; 95{\%} CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT ≤0.80 compared with patients with an FFRCT >0.80 (25 [0.80{\%}] vs. 3 [0.20{\%}]; RR: 4.22; 95{\%} CI: 1.28 to 13.95; p = 0.01). Conclusions: The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679)",
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author = "Patel, {Manesh R.} and N{\o}rgaard, {Bjarne Linde} and Fairbairn, {Timothy A.} and Koen Nieman and Takashi Akasaka and Berman, {Daniel S.} and Raff, {Gilbert L.} and {Hurwitz Koweek}, {Lynne M.} and Gianluca Pontone and Tomohiro Kawasaki and Sand, {Niels Peter R{\o}nnow} and Jensen, {Jesper M.} and Tetsuya Amano and Michael Poon and {\O}vrehus, {Kristian A.} and Jeroen Sonck and Rabbat, {Mark G.} and Sarah Mullen and {De Bruyne}, Bernard and Campbell Rogers and Hitoshi Matsuo and Bax, {Jeroen J.} and Jonathon Leipsic",
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TY - JOUR

T1 - 1-Year Impact on Medical Practice and Clinical Outcomes of FFRCT

T2 - The ADVANCE Registry

AU - Patel, Manesh R.

AU - Nørgaard, Bjarne Linde

AU - Fairbairn, Timothy A.

AU - Nieman, Koen

AU - Akasaka, Takashi

AU - Berman, Daniel S.

AU - Raff, Gilbert L.

AU - Hurwitz Koweek, Lynne M.

AU - Pontone, Gianluca

AU - Kawasaki, Tomohiro

AU - Sand, Niels Peter Rønnow

AU - Jensen, Jesper M.

AU - Amano, Tetsuya

AU - Poon, Michael

AU - Øvrehus, Kristian A.

AU - Sonck, Jeroen

AU - Rabbat, Mark G.

AU - Mullen, Sarah

AU - De Bruyne, Bernard

AU - Rogers, Campbell

AU - Matsuo, Hitoshi

AU - Bax, Jeroen J.

AU - Leipsic, Jonathon

PY - 2020/1

Y1 - 2020/1

N2 - Objectives: The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. Background: Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Methods: Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. Results: At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFRCT ≤0.80 and in 89 (5.60%) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFRCT ≤0.80 and 12 occurred in those with an FFRCT >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFRCT ≤0.80 compared with 10 (0.60%) patients with an FFRCT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT ≤0.80 compared with patients with an FFRCT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). Conclusions: The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679)

AB - Objectives: The 1-year data from the international ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) Registry of patients undergoing coronary computed tomography angiography (CTA) was used to evaluate the relationship of fractional flow reserve derived from coronary CTA (FFRCT) with downstream care and clinical outcomes. Background: Guidelines for management of chest pain using noninvasive imaging pathways are based on short- to intermediate-term outcomes. Methods: Patients (N = 5,083) evaluated for clinically suspected coronary artery disease and in whom atherosclerosis was identified by coronary CTA were prospectively enrolled at 38 international sites from July 15, 2015, to October 20, 2017. Demographics, symptom status, coronary CTA and FFRCT findings and resultant site-based treatment plans, and clinical outcomes through 1 year were recorded and adjudicated by a blinded core laboratory. Major adverse cardiac events (MACE), death, myocardial infarction (MI), and acute coronary syndrome leading to urgent revascularization were captured. Results: At 1 year, 449 patients did not have follow-up data. Revascularization occurred in 1,208 (38.40%) patients with an FFRCT ≤0.80 and in 89 (5.60%) with an FFRCT >0.80 (relative risk [RR]: 6.87; 95% confidence interval [CI]: 5.59 to 8.45; p < 0.001). MACE occurred in 55 patients, 43 events occurred in patients with an FFRCT ≤0.80 and 12 occurred in those with an FFRCT >0.80 (RR: 1.81; 95% CI: 0.96 to 3.43; p = 0.06). Time to first event (all-cause death or MI) occurred in 38 (1.20%) patients with an FFRCT ≤0.80 compared with 10 (0.60%) patients with an FFRCT >0.80 (RR: 1.92; 95% CI: 0.96 to 3.85; p = 0.06). Time to first event (cardiovascular death or MI) occurred cardiovascular death or MI occurred more in patients with an FFRCT ≤0.80 compared with patients with an FFRCT >0.80 (25 [0.80%] vs. 3 [0.20%]; RR: 4.22; 95% CI: 1.28 to 13.95; p = 0.01). Conclusions: The 1-year outcomes from the ADVANCE FFRCT Registry show low rates of events in all patients, with less revascularization and a trend toward lower MACE and significantly lower cardiovascular death or MI in patients with a negative FFRCT compared with patients with abnormal FFRCT values. (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Wave [ADVANCE]; NCT02499679)

KW - clinical outcomes

KW - clinical practice

KW - coronary computed tomography angiography

KW - FFR

KW - fractional flow reserve

KW - major adverse cardiac events

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