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Madsen KT, Nørgaard BL, Øvrehus KA, Jensen JM, Parner E, Grove EL, Fairbairn TA, Nieman K, Patel MR, Rogers C, Mullen S, Mickley H, Rohold A, Bøtker HE, Leipsic J, Sand NPR. Prognostic Value of Coronary CT Angiography-derived Fractional Flow Reserve on 3-year Outcomes in Patients with Stable Angina. Radiology 2023; 308:e230524. [PMID: 37698477 DOI: 10.1148/radiol.230524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background The prognostic value of coronary CT angiography (CTA)-derived fractional flow reserve (FFR) beyond 1-year outcomes and in patients with high levels of coronary artery calcium (CAC) is uncertain. Purpose To assess the prognostic value of coronary CTA-derived FFR test results on 3-year clinical outcomes in patients with coronary stenosis and among a subgroup of patients with high levels of CAC. Materials and Methods This study represents a 3-year follow-up of patients with new-onset stable angina pectoris who were consecutively enrolled in the Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care, known as ADVANCE (ClinicalTrials.gov: NCT02499679) registry, between December 2015 and October 2017 at three Danish sites. A high CAC was defined as an Agatston score of at least 400. A lesion-specific coronary CTA-derived FFR value of 2 cm with distal-to-stenosis value at or below 0.80 represented an abnormal test result. The primary end point was a composite of all-cause death and nonfatal spontaneous myocardial infarction. Event rates were estimated using the one-sample binomial model, and relative risk was compared between participants stratified by results of coronary CTA-derived FFR. Results This study included 900 participants: 523 participants with normal results (mean age, 64 years ± 9.6 [SD]; 318 male participants) and 377 with abnormal results from coronary CTA-derived FFR (mean age, 65 years ± 9.6; 264 male participants). The primary end point occurred in 11 of 523 (2.1%) and 25 of 377 (6.6%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 3.1; 95% CI: 1.6, 6.3; P < .001). In participants with high CAC, the primary end point occurred in four of 182 (2.2%) and 19 of 212 (9.0%) participants with normal and abnormal coronary CTA-derived FFR results, respectively (relative risk, 4.1; 95% CI: 1.4, 11.8; P = .001). Conclusion In individuals with stable angina, a normal coronary CTA-derived FFR test result identified participants with a low 3-year risk of all-cause death or nonfatal spontaneous myocardial infarction, both in the overall cohort and in participants with high CAC scores. Clinical trial registration no. NCT02499679 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Affiliation(s)
- Kristian T Madsen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Bjarne L Nørgaard
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Kristian A Øvrehus
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jesper M Jensen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik Parner
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Erik L Grove
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Timothy A Fairbairn
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Koen Nieman
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Manesh R Patel
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Campbell Rogers
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Sarah Mullen
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Mickley
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Allan Rohold
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Jonathon Leipsic
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
| | - Niels Peter R Sand
- From the Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Finsensgade 35, Esbjerg DK-6700, Denmark (K.T.M., A.R., N.P.R.S.); Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (B.L.N., J.M.J., E.L.G., H.E.B.); Department of Clinical Medicine, Faculty of Health (B.L.N., E.L.G.), and Department of Public Health, Section for Biostatistics (E.P.), Aarhus University, Aarhus, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark (K.A.Ø., H.M.); Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (T.A.F.); Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, Calif (K.N.); Division of Cardiology, Department of Medicine, Duke University, Durham, NC (M.R.P.); HeartFlow Inc, Mountain View, Calif (C.R., S.M.); Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.L.); and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark (N.P.R.S.)
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