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Published online: 2022-11-23
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Benefits of the selective invasive strategy guided by CTA and CT-FFR in patients with coronary artery disease

Mariusz Artur Dębski1, Mariusz Kruk1, Sebastian Bujak1, Marcin Demkow1, Cezary Kępka1
DOI: 10.33963/KP.a2022.0264
·
Pubmed: 36446067
Affiliations
  1. Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, Warszawa, Poland

open access

Online first
Original article
Published online: 2022-11-23

Abstract

Background: Coronary computed tomography angiography (CTA) has high diagnostic accuracy in ruling out significant stenosis of coronary arteries. The additional use of CTA- derived FFR further enhances diagnostic utility of coronary CTA. Some of the patients interrogated non-invasively have diseased coronary arteries and undergo further diagnostic testing, including invasive coronary angiography (ICA). Patients with one vessel disease may benefit from invasive interrogation limited to the diseased vessel only.

Aims: In 100 patients, we analysed the impact of a “diseased-vessel-only”, selective invasive diagnostic approach in patients undergoing ICA following coronary CTA (and CT-FFR) as compared to the traditional, “full ICA” approach. Our aim was to compare contrast volume and radiation dose used during ICA in both scenarios, seeking potential benefit for the patient in reducing those values by “diseased-vessel-only” approach.

Results: Sensitivity, specificity, positive predictive value and negative predictive value of CTA in prediction of subsequent revascularization were 96%, 75%, 51% and 99%, respectively, and for CT-FFR 90%, 90%, 69% and 97%, respectively. Using CTA as a method to guide ICA would reduce contrast volume and estimated radiation dose (ED), by 35% and 42.0% respectively (P <0.0001 for both). Taking into consideration CT-FFR results, contrast volume would be reduced by 57% and ED by 69% (P <0.0001 for both).

Conclusion: These real-world data support the concept that vessels with <50% diameter stenosis in QCT and hemodynamically insignificant in CTA-derived FFR may be skipped during ICA. Such approach would result in substantial reductions in contrast media volume used, as well as patient’s exposure to radiation during during ICA, while not leading to missed diagnoses.

Abstract

Background: Coronary computed tomography angiography (CTA) has high diagnostic accuracy in ruling out significant stenosis of coronary arteries. The additional use of CTA- derived FFR further enhances diagnostic utility of coronary CTA. Some of the patients interrogated non-invasively have diseased coronary arteries and undergo further diagnostic testing, including invasive coronary angiography (ICA). Patients with one vessel disease may benefit from invasive interrogation limited to the diseased vessel only.

Aims: In 100 patients, we analysed the impact of a “diseased-vessel-only”, selective invasive diagnostic approach in patients undergoing ICA following coronary CTA (and CT-FFR) as compared to the traditional, “full ICA” approach. Our aim was to compare contrast volume and radiation dose used during ICA in both scenarios, seeking potential benefit for the patient in reducing those values by “diseased-vessel-only” approach.

Results: Sensitivity, specificity, positive predictive value and negative predictive value of CTA in prediction of subsequent revascularization were 96%, 75%, 51% and 99%, respectively, and for CT-FFR 90%, 90%, 69% and 97%, respectively. Using CTA as a method to guide ICA would reduce contrast volume and estimated radiation dose (ED), by 35% and 42.0% respectively (P <0.0001 for both). Taking into consideration CT-FFR results, contrast volume would be reduced by 57% and ED by 69% (P <0.0001 for both).

Conclusion: These real-world data support the concept that vessels with <50% diameter stenosis in QCT and hemodynamically insignificant in CTA-derived FFR may be skipped during ICA. Such approach would result in substantial reductions in contrast media volume used, as well as patient’s exposure to radiation during during ICA, while not leading to missed diagnoses.

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Keywords

coronary computed tomography angiography, coronary angiography, coronary artery disease, fractional flow reserve, CT-FFR

About this article
Title

Benefits of the selective invasive strategy guided by CTA and CT-FFR in patients with coronary artery disease

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-11-23

Page views

78

Article views/downloads

47

DOI

10.33963/KP.a2022.0264

Pubmed

36446067

Keywords

coronary computed tomography angiography
coronary angiography
coronary artery disease
fractional flow reserve
CT-FFR

Authors

Mariusz Artur Dębski
Mariusz Kruk
Sebastian Bujak
Marcin Demkow
Cezary Kępka

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