Key result
Coronary calcification severity had no significant influence on the diagnostic performance of CT-FFR for identifying ischemia, which demonstrated an overall per-patient AUC of 0.90.
Why the study?
The study was conducted to explore the effect of coronary calcification severity on the measurements and diagnostic performance of computed tomography-derived fractional flow reserve.
Does coronary calcification severity affect the diagnostic performance of CT-FFR compared to invasive FFR in patients with evaluable CAC scores?
Observational (n=305)
Blinded
Yes
Does coronary calcification severity affect the diagnostic performance of CT-FFR compared to invasive FFR in patients with evaluable CAC scores?
Effect estimate: AUC 0.90 (95% CI 0.86-0.93)
p-value: p=0.152
CT-FFR maintains high diagnostic accuracy for identifying hemodynamically significant coronary lesions regardless of the severity of coronary calcification.
CT-FFR accuracy appears robust across calcification levels; hypothesis-generating and should not yet change practice.
Aims: To explore the effect of coronary calcification severity on the measurements and diagnostic performance of computed tomography-derived fractional flow reserve (FFR; CT-FFR). Methods: This study included 305 patients (348 target vessels) with evaluable coronary calcification (CAC) scores from CT-FFR CHINA clinical trial. The enrolled patients all received coronary CT angiography (CCTA), CT-FFR, and invasive FFR examinations within 7 days. On both per-patient and per-vessel levels, the measured values, accuracy, and diagnostic performance of CT-FFR in identifying hemodynamically significant lesions were analyzed in all CAC score groups (CAC = 0, > 0 to <100, ≥ 100 to <400, and ≥ 400), with FFR as reference standard. Results: In total, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under receiver operating characteristics curve (AUC) of CT-FFR were 85.8, 88.7, 86.9, 87.8, 87.1%, 0.90 on a per-patient level and 88.3, 89.3, 89.5, 88.2, 88.9%, 0.88 on a per-vessel level, respectively. Absolute difference of CT-FFR and FFR values tended to elevate with increased CAC scores (CAC = 0: 0.09 ± 0.10; CAC > 0 to <100: 0.06 ± 0.06; CAC ≥ 100 to <400: 0.09 ± 0.10; CAC ≥ 400: 0.11 ± 0.13; p = 0.246). However, no statistically significant difference was found in patient-based and vessel-based diagnostic performance of CT-FFR among all CAC score groups. Conclusion: This prospective multicenter trial supported CT-FFR as a viable tool in assessing coronary calcified lesions. Although large deviation of CT-FFR has a tendency to correlate with severe calcification, coronary calcification has no significant influence on CT-FFR diagnostic performance using the widely-recognized cut-off value of 0.8.
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Zhao et al. (2022) conducted an observational in Coronary artery disease (n=305). Coronary calcification severity (CAC score) vs. Different CAC score categories (0, >0 to <100, ≥100 to <400, ≥400) was evaluated on Diagnostic performance (AUC) of CT-FFR for identifying hemodynamically significant lesions on a per-patient level (AUC 0.90, 95% CI 0.86-0.93, p=0.152). Coronary calcification severity had no significant influence on the diagnostic performance of CT-FFR for identifying ischemia, which demonstrated an overall per-patient AUC of 0.90.
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