Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: Lessons from the ADVANCE Registry

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

Research output: Contribution to journalArticlepeer-review

Abstract

Aims 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). Methods and results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)3701-3711
Number of pages11
JournalEuropean Heart Journal
Volume39
Issue number41
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Coronary CT angiography
  • FFRCT
  • Fractional flow reserve
  • Invasive coronary angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: Lessons from the ADVANCE Registry'. Together they form a unique fingerprint.

Cite this