Key result
The non-invasive FFR CT planner tool showed modest agreement with invasive post-PCI FFR (0.85 vs 0.89, mean difference 0.040; 95% CI -0.10 to 0.18; p<0.001).
Why the study?
Advances in FFR CT technology allow simulation of post-stenosis removal pressure changes, but the performance of an interactive planner to predict post-PCI physiological benefits defined by invasive FFR required evaluation.
Does the FFR CT planner accurately predict invasive post-PCI FFR in patients undergoing percutaneous coronary intervention?
Observational (n=56)
Does the FFR CT planner accurately predict invasive post-PCI FFR in patients undergoing percutaneous coronary intervention?
Mean Difference: 0.04 (95% CI -0.1–0.18)
Absolute Event Rate: 0.85% vs 0.89%
p-value: p=<.001
The non-invasive FFR CT planner demonstrates significant but modest agreement with invasive post-PCI FFR, indicating potential for procedural planning but requiring technological refinement before clinical use.
May support virtual PCI planning; leaves open whether FFR CT planner reliably guides decisions in larger trials.
Objectives This study aimed to investigate the performance of computed tomography derived fractional flow reserve based interactive planner (FFR CT planner) to predict the physiological benefits of percutaneous coronary intervention (PCI) as defined by invasive post‐PCI FFR. Background Advances in FFR CT technology have enabled the simulation of hyperemic pressure changes after virtual removal of stenoses. Methods In 56 patients (63 vessels) invasive FFR measurements before and after PCI were obtained and FFR CT was calculated using pre‐PCI coronary CT angiography. Subsequently, FFR CT and invasive coronary angiography models were aligned allowing virtual removal of coronary stenoses on pre‐PCI FFR CT models in the same locations as PCI was performed. Relationships between invasive FFR and FFR CT , between post‐PCI FFR and FFR CT planner, and between delta FFR and delta FFR CT were evaluated. Results Pre PCI, invasive FFR was 0.65 ± 0.12 and FFR CT was 0.64 ± 0.13 ( p = .34) with a mean difference of 0.015 (95% CI: −0.23–0.26). Post‐PCI invasive FFR was 0.89 ± 0.07 and FFR CT planner was 0.85 ± 0.07 ( p < .001) with a mean difference of 0.040 (95% CI: −0.10–0.18). Delta invasive FFR and delta FFR CT were 0.23 ± 0.12 and 0.21 ± 0.12 ( p = .09) with a mean difference of 0.025 (95% CI: −0.20–0.25). Significant correlations were found between pre‐PCI FFR and FFR CT (r = 0.53, p < .001), between post‐PCI FFR and FFR CT planner (r = 0.41, p = .001), and between delta FFR and delta FFR CT (r = 0.57, p < .001). Conclusions The non‐invasive FFR CT planner tool demonstrated significant albeit modest agreement with post‐PCI FFR and change in FFR values after PCI. The FFR CT planner tool may hold promise for PCI procedural planning; however, improvement in technology is warranted before clinical application.
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Bom et al. (2020) conducted an observational in Coronary artery disease undergoing PCI (n=56). Computed tomography-derived fractional flow reserve based interactive planner (FFR CT planner) vs. Invasive post-PCI FFR was evaluated on Post-PCI FFR value (MD 0.040, 95% CI -0.10-0.18, p=<.001). The non-invasive FFR CT planner tool showed modest agreement with invasive post-PCI FFR (0.85 vs 0.89, mean difference 0.040; 95% CI -0.10 to 0.18; p<0.001).
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