FFRCT-P reduced the underestimation of true stenosis contribution to a mean error of 7% compared to 42% error with FFRpullback in patients with serial coronary artery disease after PCI.
Does a novel FFRCT-based PCI planning tool more accurately predict the true FFR contribution of individual stenoses in serially diseased coronary arteries compared to conventional FFR pullback and FFRCT?
A novel noninvasive FFRCT-based PCI planning tool significantly improves the prediction of true stenosis hemodynamic contribution in serially diseased coronary arteries compared to conventional invasive FFR pullback.
Effect estimate: mean difference of 0.05 (P<0.001)
Absolute Event Rate: 0.01% vs 0.06%
p-value: p=<0.001
Background: Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR CT ). We subsequently describe and test the accuracy of a novel noninvasive FFR CT -derived percutaneous coronary intervention (PCI) planning tool (FFR CT-P ) in predicting the true significance of individual stenoses. Methods and Results: Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR CT -derived post hoc for each vessel and stenosis (FFR CT ). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR pullback ). The true FFR attributable to individual lesions (FFR true ) was then measured following PCI of one of the lesions. The predictive accuracy of FFR pullback , FFR CT , and the novel technique (FFR CT-P ) was then assessed against FFR true . From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR CT and FFR CT-P calculation. When assessing the distal effect of all lesions, FFR CT correlated moderately well with invasive FFR ( R =0.71; P <0.001). For lesion-specific assessment, there was significant underestimation of FFR true using FFR pullback (mean discrepancy, 0.06±0.05; P <0.001, representing a 42% error) and conventional trans-lesional FFR CT (0.05±0.06; P <0.001, 37% error). Using FFR CT-P , stenosis underestimation was significantly reduced to a 7% error (0.01±0.05; P <0.001). Conclusions: FFR pullback and conventional FFR CT significantly underestimate true stenosis contribution in serial coronary artery disease. A novel noninvasive FFR CT -based PCI planner tool more accurately predicts the true FFR contribution of each stenosis in serial coronary artery disease.
Modi et al. (Fri,) conducted a other in Serial coronary artery disease (n=24). FFRCT-P (noninvasive FFRCT-derived PCI planning tool) vs. Conventional FFRpullback and FFRCT was evaluated on True FFR contribution prediction after PCI (mean difference of 0.05 (P<0.001), p=<0.001). FFRCT-P reduced the underestimation of true stenosis contribution to a mean error of 7% compared to 42% error with FFRpullback in patients with serial coronary artery disease after PCI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: