FFRCT demonstrated superior diagnostic accuracy over CCTA for coronary artery disease in patients with moderate to severe calcification (AUC 0.80 vs 0.62; P<0.001).
Observational (n=492)
Yes
Does FFRCT improve diagnostic accuracy for coronary artery disease compared to CCTA in patients with coronary calcification?
FFRCT provides superior diagnostic accuracy compared to CCTA for detecting coronary artery disease, particularly in patients with moderate to severe coronary calcification.
Effect estimate: AUC 0.80 for FFRCT vs 0.62 for CCTA (95% CI 0.74-0.85 vs 0.56-0.68)
p-value: p=<0.001
This multicenter study evaluated the diagnostic accuracy of coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFR CT ) in diagnosing coronary artery disease (CAD), focusing on the impact of coronary calcification, using invasive coronary angiography (ICA) as the reference. The study analyzed 4172 patients from three centers who underwent CCTA and FFR CT between August 2021 and August 2022. Exclusion criteria included the absence of ICA within 90 days after CCTA, left main disease, previous coronary revascularization, or unmeasurable agatston score (AS). The study included 492 patients. In patients with less than mild calcification (AS<100), the area under the receiver-operating characteristic curve (AUC) for FFR CT was superior to CCTA (0.8795% confidence interval (CI): 0.82 - 0.92 vs. 0.7895% CI: 0.73 - 0.84, P=0.009). As the severity of calcification increased, both CCTA and FFR CT showed reduced diagnostic efficacy, but FFR CT maintained higher accuracy. In patients with more than moderate calcification (AS≥100), FFR CT significantly outperformed CCTA (0.80 95% CI: 0.74 - 0.85 vs. 0.62 95% CI:0.56 - 0.68, P<0.001). Furthermore, integrating FFR CT with CCTA and baseline factors using least absolute shrinkage and selection operator (LASSO) improved diagnostic performance in patients with more than moderate calcification (AS≥100) than FFR CT (0.8595% CI: 0.78 - 0.92 vs. 0.8195% CI: 0.72 - 0.90, P=0.003). FFR CT offers superior diagnostic accuracy over CCTA, particularly in patients with moderate to severe calcification. Furthermore, the LASSO model enhances diagnostic performance in these cases, demonstrating potential for improving CAD diagnosis in patients with significant coronary calcification.
Liu et al. (Sat,) conducted a observational in Coronary artery disease (CAD) (n=492). CT-derived fractional flow reserve (FFRCT) vs. Coronary computed tomography angiography (CCTA) was evaluated on Diagnostic accuracy (AUC) for coronary artery disease in patients with moderate to severe calcification (Agatston score ≥100) (AUC 0.80 for FFRCT vs 0.62 for CCTA, 95% CI 0.74-0.85 vs 0.56-0.68, p=<0.001). FFRCT demonstrated superior diagnostic accuracy over CCTA for coronary artery disease in patients with moderate to severe calcification (AUC 0.80 vs 0.62; P<0.001).