In diabetic patients with non-obstructive coronary artery disease, a high global trans-lesional CT-FFR gradient (≥0.20) was associated with a significantly higher risk of MACE (HR 2.86) compared to a low gradient.
Cohort (n=1,215)
Blinded to clinical outcomes
No
Does the global trans-lesional CT-FFR gradient (GΔCT-FFR) predict major adverse cardiovascular events in diabetic patients with suspected non-obstructive CAD?
In diabetic patients with suspected CAD, the global trans-lesional CT-FFR gradient (GΔCT-FFR) provides incremental prognostic value for long-term cardiovascular events beyond traditional clinical and anatomical risk scores.
Effect estimate: HR 2.86 (95% CI 1.75-4.68)
Absolute Event Rate: 5.02% vs 1.17%
p-value: p=<0.001
BACKGROUND: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) enables physiological assessment and risk stratification, which is of significance in diabetic patients with nonobstructive coronary artery disease (CAD). We aim to evaluate prognostic value of the global trans-lesional CT-FFR gradient (GΔCT-FFR), a novel metric, in patients with diabetes without flow-limiting stenosis. METHODS: Patients with diabetes suspected of having CAD were prospectively enrolled. GΔCT-FFR was calculated as the sum of trans-lesional CT-FFR gradient in all epicardial vessels greater than 2 mm. Patients were stratified into low-gradient without flow-limiting group (CT-FFR > 0.75 and GΔCT-FFR 0.75 and GΔCT-FFR ≥ 0.20), and flow-limiting group (CT-FFR ≤ 0.75). Discriminant ability for major adverse cardiovascular events (MACE) prediction was compared among 4 models model 1: Framingham risk score; model 2: model 1 + Leiden score; model 3: model 2 + high-risk plaques (HRP); model 4: model 3 + GΔCT-FFR to determine incremental prognostic value of GΔCT-FFR. RESULTS: Of 1215 patients (60.1 ± 10.3 years, 53.7% male), 11.3% suffered from MACE after a median follow-up of 57.3 months. GΔCT-FFR (HR: 2.88, 95% CI 1.76-4.70, P < 0.001) remained independent risk factors of MACE in multivariable analysis. Compared with the low-gradient without flow-limiting group, the high-gradient without flow-limiting group (HR: 2.86, 95% CI 1.75-4.68, P < 0.001) was associated with higher risk of MACE. Among the 4 risk models, model 4, which included GΔCT-FFR, showed the highest C-statistics (C-statistics: 0.75, P = 0.002) as well as a significant net reclassification improvement (NRI) beyond model 3 (NRI: 0.605, P < 0.001). CONCLUSIONS: In diabetic patients with non-obstructive CAD, GΔCT-FFR was associated with clinical outcomes at 5 year follow-up, which illuminates a novel and feasible approach to improved risk stratification for a global hemodynamic assessment of coronary artery in diabetic patients.
Liu et al. (Wed,) conducted a cohort in Type 2 diabetes with suspected non-obstructive coronary artery disease (n=1,215). High global trans-lesional CT-FFR gradient (GΔCT-FFR ≥ 0.20) vs. Low global trans-lesional CT-FFR gradient (GΔCT-FFR < 0.20) was evaluated on Major adverse cardiovascular events (MACE) (HR 2.86, 95% CI 1.75-4.68, p=<0.001). In diabetic patients with non-obstructive coronary artery disease, a high global trans-lesional CT-FFR gradient (≥0.20) was associated with a significantly higher risk of MACE (HR 2.86) compared to a low gradient.