Abstract
Background
Coronary computed tomography-derived fractional flow reserve (FFR-CT) assesses whether coronary artery lesions will result in myocardial ischemia. This study aimed to evaluate the predictive value of FFR-CT for cardiovascular events in patients with coronary artery disease (CAD).
Methods
Data were collected retrospectively from patients with CAD who underwent FFR-CT at our hospital from January 2020 to February 2022 (1-year average follow-up). Patients were divided into ischemic (FFR-CT ≤ 0.80) and non-ischemic (FFR-CT > 0.80) groups. The incidence of endpoint events (cardiac death, acute myocardial infarction, unplanned revascularization, unstable angina, and stable angina) was calculated. The FFR-CT value was correlated with endpoint events using Cox regression models and Kaplan–Meier survival curves.
Results
We recruited 134 patients (93 [69.4%] and 41 [30.6%] patients in the ischemic and non-ischemic groups, respectively). The ischemic group had a higher proportion of men, patients with type 2 diabetes and hypertension, and patients taking antiplatelet drugs and β‑blockers than did the non-ischemic group (all p < 0.05), whereas other parameters were comparable. Multivariate Cox regression analysis revealed no significant differences in cardiac death, acute myocardial infarction, unplanned revascularization, and unstable angina between the groups. The incidence of stable angina events (hazard ratio: 3.092, 95% confidence interval: 1.362–7.022, p = 0.007) was significantly higher in the ischemic group. Kaplan–Meier survival analysis revealed a significant difference in event-free survival for stable angina between the groups (p = 0.002).
Conclusion
In patients with CAD, FFR-CT showed an independent predictive value for stable angina within 1 year of examination.
Zusammenfassung
Hintergrund
Mit der durch koronare Computertomographie bestimmten fraktionellen Flussreserve (FFR-CT) lässt sich beurteilen, ob Läsionen der Koronararterien zu einer Myokardischämie führen werden. Ziel der vorliegenden Studie war es, den prädiktiven Wert der FFR-CT für kardiovaskuläre Ereignisse bei Patienten mit koronarer Herzkrankheit (KHK) zu untersuchen.
Methoden
Dazu wurden retrospektiv Daten von Patienten mit KHK erfasst, bei denen in der Klinik der Autoren zwischen Januar 2020 und Februar 2022 (Ein-Jahres-Follow-up) eine FFR-CT durchgeführt wurde. Die Patienten wurden in eine Ischämiegruppe (FFR-CT ≤ 0,80) und eine Gruppe ohne Ischämie (FFR-CT > 0,80) eingeteilt. Die Inzidenz der Endpunktereignisse (Herztod, akuter Herzinfarkt, ungeplante Revaskularisierung, instabile Angina und stabile Angina) wurde berechnet. Der FFR-CT-Wert wurde anhand von Cox-Regressions-Modellen und Kaplan-Meier-Überlebenskurven mit den Endpunktereignissen korreliert.
Ergebnisse
Für die Studie wurden 134 Patienten rekrutiert (93 [69,4%] in der Ischämiegruppe bzw. 41 [30,6%] Patienten in der Gruppe ohne Ischämie). In der Ischämiegruppe gab es einen höheren Anteil an Männern, Patienten mit Typ-2-Diabetes und Hypertonie sowie Patienten, die Thrombozytenaggregationshemmer und β‑Blocker einnahmen, als in der Gruppe ohne Ischämie (alle p < 0,05), während andere Parameter vergleichbar waren. Die multivariate Cox-Regressions-Analyse ergab keine signifikanten Unterschiede in Bezug auf Herztod, akuten Herzinfarkt, ungeplante Revaskularisierung und instabile Angina zwischen den Gruppen. In der Ischämiegruppe war die Inzidenz von Ereignissen mit stabiler Angina (Hazard Ratio: 3,092; 95%-Konfidenzintervall: 1,362–7,022; p = 0,007) signifikant höher. Die Kaplan-Meier-Überlebensanalyse ergab einen signifikanten Unterschied zwischen den Gruppen für das ereignisfreie Überleben in Bezug auf stabile Angina (p = 0,002).
Schlussfolgerung
Bei Patienten mit KHK wurde für die FFR-CT ein unabhängiger prädiktiver Wert in Bezug auf stabile Angina innerhalb eines Jahres nach der Untersuchung nachgewiesen.
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Acknowledgements
The authors would like to thank Shenzhen RaySight Intelligent Medical Technology Co., Ltd. (China) for their assistance in calculating FFR-CT value and all the participants and all staff members of this study for their contributions.
Funding
The study was supported by the Construction Fund of Key Medical Disciplines of Hangzhou (grant number: OO20200121). The funder had a role in the collection of data and in the decision to submit the article for publication.
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YX guarantees the integrity of the study. YX and ML contributed to the conception and design. HH and ML conducted the literature search. HH, ML, YY, and YC conducted the clinical studies. HH, ML, and YY conducted the experimental analyses and data analysis. HH, ML, and YY performed the statistical analysis. HH, ML prepared the original manuscript and HH, ML, and YX edited the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.
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Conflict of interest
H. Han, M. Liu, Y. Yu, Y. Chen and Y. Xu declare that they have no competing interests.
The study was approved by the Clinical Application of Medical Technology and Research Ethics Committee of Hangzhou First People’s Hospital. All methods were carried out in accordance with relevant guidelines and regulations. All patients provided written informed consent for participation.
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The authors Hongwei Han and Meijun Liu contributed equally to the manuscript.
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Han, H., Liu, M., Yu, Y. et al. Predictive value of coronary artery computed tomography-derived fractional flow reserve for cardiovascular events in patients with coronary artery disease. Herz (2023). https://doi.org/10.1007/s00059-023-05220-3
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DOI: https://doi.org/10.1007/s00059-023-05220-3
Keywords
- Atherosclerotic heart disease
- Cardiovascular events
- Coronary arteriosclerosis
- Coronary computed tomography-derived fractional flow reserve
- Predictive value