Coronary interventions

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

EuroIntervention 2021;17:576-583. DOI: 10.4244/EIJ-D-20-00905

Jelmer Westra
Jelmer Westra1,2, MD; Zehang Li2, BSc; Laust Dupont Rasmussen3, MD; Simon Winther3, MD, PhD; Guanyu Li2, BSc; Louise Nissen3, MD, PhD; Steffen E. Petersen4,5, MSc, MPH, MD, DPhil; June Anita Ejlersen6, MD, PhD; Christin Isaksen7, MD; Lars Christian Gormsen8, MD, PhD; Grazina Urbonaviciene7, MD, PhD; Ashkan Eftekhari1, MD, PhD; Tingwen Weng9, MD; Xinkai Qu9, MD, PhD; Hans Erik Bøtker1, MD, PhD, DMSci; Evald Høj Christiansen1, MD, PhD; Niels Ramsing Holm1, MD; Morten Bøttcher3, MD, PhD; Shengxian Tu2, PhD
1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 2. School of Biochemical engineering, Shanghai Jiao 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

Background: 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).

Aims: We aimed to compare 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: A paired analysis of CT-QFR and MPS or CMR, with an invasive FFR-based classification as reference standard was carried out. Symptomatic patients with >50% diameter stenosis on coronary CTA were randomised to MPS or CMR and referred for invasive coronary angiography.

Results: 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. 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 a second-line test was at least similar to MPS and CMR for the evaluation of obstructive CAD in symptomatic patients presenting with ≥50% diameter stenosis on coronary CTA.

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