Abstract
Abstract Background Based on excellent clinical outcomes data, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by ESC guidelines for diagnosing obstructive coronary artery disease (OCAD) (1). The impact of FFRCT use on cardiovascular outcomes after revascularization is not well known. Purpose To assess the impact of FFRCT use on the post-procedural myocardial injury and long-term clinical outcomes of patients with OCAD undergoing myocardial revascularization. Methods Patients with suspected OCAD on CCTA (at least one stenosis of >50% in any vessel) were included from a 2013-2021 tertiary hospital registry. Propensity score adjusted Cox- regression and logistic regression analysis, respectively were used to assess the impact of FFRCT on the outcomes of patients with OCAD undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Post-revascularization myocardial injury (PMI) was defined as cardiac troponin (hs -cTnT) > 5 times the 99th percentile URL for PCI and hs- cTnT > 10 times the 99th percentile URL for CABG. Major adverse cardiovascular events (MACE) were defined as a composite endpoint of all – cause mortality, hospitalization for acute myocardial infarction, stroke, hospitalization for heart failure and repeated revascularization. Results Among 7541 patients, 1601 had suspected CCTA - derived OCAD. 559 patients were revascularized: 386(69.05%) by PCI, 166(29.7%) by CABG. FFRCT was performed in 252(45.1%) patients. During a follow-up of 4.4±2.2 years, 137(24.5%) patients experienced MACE. Survival analysis indicated significant differences in MACE and all-cause mortality–rates between FFRCT use and no FFRCT use (log- rank p = 0.033 and 0.004). A non–significant trend towards reduced MACE risk by using FFRCT (HR 0.736, 95% CI 0.513-1.055, P=0.095) and a significant reduction in all-cause mortality (HR 0.476, 95% CI 0.230–0.985, P=0.046) were observed. In the CABG group, FFRCT was associated with lower PMI incidence (5.3% vs. 15.6%, p=0.044). Multivariable analysis revealed no significant association between FFRCT use and PMI. Conclusion Using an observational design, this study demonstrates for the first time that FFRCT is able to reduce post- myocardial revascularization MACE. Contrary to previous studies on invasive FFR, this observed FFRCT - related MACE reduction was mainly driven by the reduction in all-cause mortality. No clear reduction of PMI was observed suggesting that the potential adjunctive value of FFRCT was not simply related to some technical improvements in the planning of PCI or CABG procedures. Even if derived from a large real-world registry, these promising observations will need to be confirmed by randomized studies. Survival analysis Forest Plot - multivariables analysis
Published Version
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