Clinical Use of CT-Derived Fractional Flow Reserve in the Emergency Department

JACC Cardiovasc Imaging. 2020 Feb;13(2 Pt 1):452-461. doi: 10.1016/j.jcmg.2019.05.025. Epub 2019 Jul 17.

Abstract

Objectives: This study sought to examine the feasibility, safety, clinical outcomes, and costs associated with computed tomography-derived fractional flow reserve (FFRCT) in acute chest pain (ACP) patients in a coronary computed tomography angiography (CTA)-based triage program.

Background: FFRCT is useful in determining lesion-specific ischemia in patients with stable ischemic heart disease, but its utility in ACP has not been studied.

Methods: ACP patients with no known coronary artery disease undergoing coronary CTA and coronary CTA with FFRCT were studied. FFRCT ≤0.80 was considered positive for hemodynamically significant stenosis.

Results: Among 555 patients, 297 underwent coronary CTA and FFRCT (196 negative, 101 positive), whereas 258 had coronary CTA only. The rejection rate for FFRCT was 1.6%. At 90 days, there was no difference in major adverse cardiac events (including death, nonfatal myocardial infarction, and unexpected revascularization after the index visit) between the coronary CTA and FFRCT groups (4.3% vs. 2.7%; p = 0.310). Diagnostic failure, defined as discordance between the coronary CTA or FFRCT results with invasive findings, did not differ between the groups (1.9% vs. 1.68%; p = NS). No deaths or myocardial infarction occurred with negative FFRCT when revascularization was deferred. Negative FFRCT was associated with higher nonobstructive disease on invasive coronary angiography (56.5%) than positive FFRCT (8.0%) and coronary CTA (22.9%) (p < 0.001). There was no difference in overall costs between the coronary CTA and FFRCT groups ($8,582 vs. $8,048; p = 0.550).

Conclusions: In ACP, FFRCT is feasible, with no difference in major adverse cardiac events and costs compared with coronary CTA alone. Deferral of revascularization is safe with negative FFRCT, which is associated with higher nonobstructive disease on invasive angiography.

Keywords: FFR(CT); acute chest pain; coronary CT angiography; emergency department.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angina Pectoris / diagnostic imaging*
  • Angina Pectoris / economics
  • Angina Pectoris / physiopathology
  • Angina Pectoris / therapy
  • Cardiology Service, Hospital* / economics
  • Computed Tomography Angiography* / economics
  • Coronary Angiography* / economics
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / economics
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / economics
  • Coronary Stenosis / physiopathology
  • Coronary Stenosis / therapy
  • Emergency Service, Hospital* / economics
  • Feasibility Studies
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Hospital Costs
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Registries
  • Reproducibility of Results
  • Retrospective Studies
  • Triage