Abstract 15723: Assessing Revascularization Strategies: The Impact of Heart Flow Analysis on Coronary Computed Tomography Angiography

Abstract

Introduction: Fractional Flow Reserve (FFR) is a technique used to assess the severity of coronary artery disease. Hypothesis: This study aimed to compare the impact of Heart Flow analysis, a CT-based FFR analysis, on patients who underwent Coronary Computed Tomography Angiography (C-CTA) at an Appalachian hospital. Methods: We collected data from January 2nd, 2019, to March 1st, 2023, from the data warehouse at Charleston Area Medical Center. The study included 5,470 patients with CTA, which were divided into two cohorts: 4,750 patients without Heart Flow analysis and 900 patients with Heart Flow analysis. Propensity score matching (PSM) was used to create two well-matched cohorts for comparative analysis. Results: Out of the total patients, 900 (16.4%) received Heart Flow analysis in addition to C-CTA, while 4,750 (83.6%) had C-CTA alone. The group of patients undergoing Heart Flow analysis had a higher prevalence of key comorbidities, including hypertension, diabetes, and prior history of myocardial infarction. After matching, both groups consisted of 900 patients each. Interestingly, while HDL cholesterol levels were similar between the groups, the Heart Flow group demonstrated lower levels of non-HDL cholesterol (102.0 vs 110 mg/dL, p=0.05), total cholesterol (147.6 vs 156 mg/dL, p=0.01), and LDL cholesterol (74.1 vs 81.8 mg/dL, p=0.05). The all-cause mortality rate was similar between the Heart Flow group and the non-Heart Flow group (2.3% vs 2.3%, p=1.00), as was the rate of myocardial infarction (3.5% vs 3.5%, p=1.00). However, the Heart Flow group exhibited a significantly higher rate of stent implantation (21.0% vs 9.2%, p<0.001) and bypass surgery (31.1% vs 1.3%, p=0.01). Conclusions: Heart Flow analysis integrated with C-CTA provides valuable insights into the selection of revascularization strategies for patients with coronary artery disease. While it did not significantly impact all-cause mortality and myocardial infarction rates compared to C-CTA alone, the utilization of Heart Flow analysis was associated with higher rates of stent implantation and bypass surgery. These findings highlight the potential of Heart Flow analysis in guiding the choice of optimal revascularization methods and improving outcomes.