The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

One-step anatomic and function testing by cardiac CT versus second-line functional testing in symptomatic patients with coronary artery stenosis: head-to-head comparison of CT-derived fractional flow reserve and myocardial perfusion imaging

DOI: 10.4244/EIJ-D-20-00905

1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
2.School of Biochemical engineering, Shanghai Jioa Tong University, Shanghai, China
3. Department of Cardiology, Hospital Unit West Jutland, Herning, Denmark
4. Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
5. William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
6. Department of Nuclear Medicine, Hospital Unit West Jutland, Herning Denmark
7. Department of Radiology, Regional Hospital of Silkeborg, Silkeborg, Denmark
8. Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
9. Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Aims: CT-QFR is a novel coronary computed tomography angiography (CTA) based method for on-site evaluation of patients with suspected obstructive coronary artery disease (CAD). We compared the diagnostic performance of CT-QFR with myocardial perfusion scintigraphy (MPS) and cardiovascular magnetic resonance (CMR) as second-line tests in patients with suspected obstructive CAD after coronary CTA.

Methods and results: Paired analysis of CT-QFR and MPS or CMR, with an invasive FFR-based classification as reference standard. Symptomatic patients with >50% diameter stenosis on coronary CTA were randomized to MPS or CMR and referred for invasive coronary angiography. The rate of coronary CTA not feasible for CT-QFR analysis was 17%. Paired patient-level data were available for 118 patients in the MPS group and 113 in the CMR group, respectively. Patient-level diagnostic accuracy was better for CT-QFR than for both MPS ((82.2% (95%CI 75.2-89.2) vs. 70.3% (95%CI 62.0-78.7), p=0.029) and CMR ((77.0% (95%CI 69.1-84.9) vs. 65.5% (95%CI 56.6-74.4), p=0.047). Following a positive coronary CTA and with the intention-to diagnose, CT-QFR, CMR and MPS were equally suitable as rule-in and rule-out modalities.

Conclusions: The diagnostic performance of CT-QFR as second-line test was at least similar to MPS and CMR for the evaluation of obstructive coronary artery disease in symptomatic patients presenting with ³50% diameter stenosis on coronary CTA.

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