Kristian Tækker Madsen , Bjarne Linde Nørgaard , Kristian Altern Øvrehus , Jesper Møller Jensen , Erik Parner , Erik Lerkevang Grove , Martin B. Mortensen , Nadia Iraqi , Timothy A. Fairbairn , Koen Nieman , Manesh R. Patel , Campbell Rogers , Sarah Mullen , Hans Mickley , Kristian Korsgaard Thomsen , Hans Erik Bøtker , Jonathon Leipsic , Niels Peter Rønnow Sand
{"title":"稳定型心绞痛患者的 FFRCT 血管再通完整性：与不良心血管后果的关系","authors":"Kristian Tækker Madsen , Bjarne Linde Nørgaard , Kristian Altern Øvrehus , Jesper Møller Jensen , Erik Parner , Erik Lerkevang Grove , Martin B. Mortensen , Nadia Iraqi , Timothy A. Fairbairn , Koen Nieman , Manesh R. Patel , Campbell Rogers , Sarah Mullen , Hans Mickley , Kristian Korsgaard Thomsen , Hans Erik Bøtker , Jonathon Leipsic , Niels Peter Rønnow Sand","doi":"10.1016/j.jcct.2024.07.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.</p></div><div><h3>Objectives</h3><p>To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR<sub>CT</sub>) and cardiovascular outcomes in patients with stable angina.</p></div><div><h3>Methods</h3><p>Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR<sub>CT</sub> value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR<sub>CT</sub> ≤ 0.80 were categorized as: Completely revascularized (CR-FFR<sub>CT</sub>), all vessels with FFR<sub>CT</sub> ≤ 0.80 revascularized; incompletely revascularized (IR-FFR<sub>CT</sub>), ≥ 1 vessels with FFR<sub>CT</sub> ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.</p></div><div><h3>Results</h3><p>Amongst 900 patients and 1759 vessels, FFR<sub>CT</sub> was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR<sub>CT</sub> (15/210 [7.1%]) compared to CR-FFR<sub>CT</sub> (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01–8.8, p = 0.036, and to normal FFR<sub>CT</sub> (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6–42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFR<sub>CT</sub> ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFR<sub>CT</sub> ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFR<sub>CT</sub> > 0.80 (10/1223 [0.8%]), p < 0.001.</p></div><div><h3>Conclusion</h3><p>Incomplete revascularization of patients with lesion-specific FFR<sub>CT</sub> ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFR<sub>CT</sub> > 0.80.</p></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":null,"pages":null},"PeriodicalIF":5.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1934592524003952/pdfft?md5=c2cbb17e53d2423dfd396564a4f7159a&pid=1-s2.0-S1934592524003952-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Completeness of revascularization by FFRCT in stable angina: Association to adverse cardiovascular outcomes\",\"authors\":\"Kristian Tækker Madsen , Bjarne Linde Nørgaard , Kristian Altern Øvrehus , Jesper Møller Jensen , Erik Parner , Erik Lerkevang Grove , Martin B. Mortensen , Nadia Iraqi , Timothy A. Fairbairn , Koen Nieman , Manesh R. Patel , Campbell Rogers , Sarah Mullen , Hans Mickley , Kristian Korsgaard Thomsen , Hans Erik Bøtker , Jonathon Leipsic , Niels Peter Rønnow Sand\",\"doi\":\"10.1016/j.jcct.2024.07.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.</p></div><div><h3>Objectives</h3><p>To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFR<sub>CT</sub>) and cardiovascular outcomes in patients with stable angina.</p></div><div><h3>Methods</h3><p>Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFR<sub>CT</sub> value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFR<sub>CT</sub> ≤ 0.80 were categorized as: Completely revascularized (CR-FFR<sub>CT</sub>), all vessels with FFR<sub>CT</sub> ≤ 0.80 revascularized; incompletely revascularized (IR-FFR<sub>CT</sub>), ≥ 1 vessels with FFR<sub>CT</sub> ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.</p></div><div><h3>Results</h3><p>Amongst 900 patients and 1759 vessels, FFR<sub>CT</sub> was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFR<sub>CT</sub> (15/210 [7.1%]) compared to CR-FFR<sub>CT</sub> (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01–8.8, p = 0.036, and to normal FFR<sub>CT</sub> (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6–42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFR<sub>CT</sub> ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFR<sub>CT</sub> ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFR<sub>CT</sub> > 0.80 (10/1223 [0.8%]), p < 0.001.</p></div><div><h3>Conclusion</h3><p>Incomplete revascularization of patients with lesion-specific FFR<sub>CT</sub> ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFR<sub>CT</sub> > 0.80.</p></div>\",\"PeriodicalId\":49039,\"journal\":{\"name\":\"Journal of Cardiovascular Computed Tomography\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1934592524003952/pdfft?md5=c2cbb17e53d2423dfd396564a4f7159a&pid=1-s2.0-S1934592524003952-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Computed Tomography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1934592524003952\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Computed Tomography","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1934592524003952","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Completeness of revascularization by FFRCT in stable angina: Association to adverse cardiovascular outcomes
Background
The prognostic impact of complete coronary revascularization relative to non-invasive testing methods is unknown.
Objectives
To assess the association between completeness of revascularization defined by CTA-derived fractional flow reserve (FFRCT) and cardiovascular outcomes in patients with stable angina.
Methods
Multicenter 3-year follow-up study of patients with new onset stable angina and ≥ 30% stenosis by CTA. The lesion-specific FFRCT value (two cm-distal-to-stenosis) was registered in all vessels with stenosis and considered abnormal when ≤ 0.80. Patients with FFRCT ≤ 0.80 were categorized as: Completely revascularized (CR-FFRCT), all vessels with FFRCT ≤ 0.80 revascularized; incompletely revascularized (IR-FFRCT), ≥ 1 vessels with FFRCT ≤ 0.80 non-revascularized. Early revascularization (< 90 days from index CTA) categorized vessels as revascularized. The primary endpoint comprised cardiovascular death and non-fatal myocardial infarction; the secondary endpoint vessel-specific late revascularization and non-fatal myocardial infarction.
Results
Amongst 900 patients and 1759 vessels, FFRCT was ≤ 0.80 in 377 (42%) patients, 536 (30%) vessels; revascularization was performed in 244 (27%) patients, 340 (19%) vessels. Risk of the primary endpoint was higher for IR-FFRCT (15/210 [7.1%]) compared to CR-FFRCT (4/167 [2.4%]), RR: 2.98; 95% CI: 1.01–8.8, p = 0.036, and to normal FFRCT (3/523 [0.6%]), RR: 12.45; 95% CI: 3.6–42.6, p < 0.001. Incidence of the secondary endpoint was higher in non-revascularized vessels with FFRCT ≤ 0.80 (29/250 [12%]) compared to revascularized vessels with FFRCT ≤ 0.80 (5/286 [1.7%]), p = 0.001, and to vessels with FFRCT > 0.80 (10/1223 [0.8%]), p < 0.001.
Conclusion
Incomplete revascularization of patients with lesion-specific FFRCT ≤ 0.80 is associated to unfavorable cardiovascular outcomes compared to those with complete revascularization or FFRCT > 0.80.
期刊介绍：
The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.
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