Temporal changes in FFRCT-Guided Management of Coronary Artery Disease – Lessons from the ADVANCE Registry

Fay Nous, Ricardo P.J. Budde, Timothy A. Fairbairn, Takashi Akasaka, Bjarne L. Nørgaard, Daniel S. Berman, Gilbert Raff, Lynne M. Hurwitz-Koweek, Gianluca Pontone, Tomohiro Kawasaki, Niels Peter R. 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, Manesh R. Patel, Koen Nieman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFRCT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFRCT within the ADVANCE registry. Methods: 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FFRCT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles. Results: The number of patients with a ≥70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1–3). The rate of positive FFRCT ≤0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFRCT ≤0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts. Conclusions: Growing experience with FFRCT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFRCT.

Original languageEnglish
JournalJournal of Cardiovascular Computed Tomography
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Angina
  • Computerized tomography
  • Coronary artery disease
  • Fractional flow reserve
  • Ischemia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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