Anzeige
Erschienen in:
17.02.2022 | Cardiac
One-year outcomes of CCTA alone versus machine learning–based FFRCT for coronary artery disease: a single-center, prospective study
Erschienen in: European Radiology | Ausgabe 8/2022
Einloggen, um Zugang zu erhaltenAbstract
Objectives
To explore downstream management and outcomes of machine learning (ML)–based CT derived fractional flow reserve (FFRCT) strategy compared with an anatomical coronary computed tomography angiography (CCTA) alone assessment in participants with intermediate coronary artery stenosis.
Methods
In this prospective study conducted from April 2018 to March 2019, participants were assigned to either the CCTA or FFRCT group. The primary endpoint was the rate of invasive coronary angiography (ICA) that demonstrated non-obstructive disease at 90 days. Secondary endpoints included coronary revascularization and major adverse cardiovascular events (MACE) at 1-year follow-up.
Results
In total, 567 participants were allocated to the CCTA group and 566 to the FFRCT group. At 90 days, the rate of ICA without obstructive disease was higher in the CCTA group (33.3%, 39/117) than that (19.8%, 19/96) in the FFRCT group (risk difference [RD] = 13.5%, 95% confidence interval [CI]: 8.4%, 18.6%; p = 0.03). The ICA referral rate was higher in the CCTA group (27.5%, 156/567) than in the FFRCT group (20.3%, 115/566) (RD = 7.2%, 95% CI: 2.3%, 12.1%; p = 0.003). The revascularization-to-ICA ratio was lower in the CCTA group than that in the FFRCT group (RD = 19.8%, 95% CI: 14.1%, 25.5%, p = 0.002). MACE was more common in the CCTA group than that in the FFRCT group at 1 year (HR: 1.73; 95% CI: 1.01, 2.95; p = 0.04).
Conclusion
In patients with intermediate stenosis, the FFRCT strategy appears to be associated with a lower rate of referral for ICA, ICA without obstructive disease, and 1-year MACE when compared to the anatomical CCTA alone strategy.
Key Points
• In stable patients with intermediate stenosis, ML-based FFR
CT
strategy was associated with a lower referral ICA rate, a lower normalcy rate of ICA, and higher revascularization-to-ICA ratio than the CCTA strategy.
• Compared with the CCTA strategy, ML-based FFR
CT
shows superior outcome prediction value which appears to be associated with a lower rate of 1-year MACE.
• ML-based FFR
CT
strategy as a non-invasive “one-stop-shop” modality may be the potential to change diagnostic workflows in patients with suspected coronary artery disease.