Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry

抄録

Background:Coronary computed tomography angiography (cCTA)-derived fractional flow reserve (FFR_CT) is a promising diagnostic method for the evaluation of coronary artery disease (CAD). However, clinical data regarding FFR_CTin Japan are scarce, so we assessed the clinical impact of using FFR_CTin a Japanese population.

Methods and Results:The ADVANCE registry is an international prospective FFR_CTregistry of patients suspected of CAD. Of 5,083 patients, 1,829 subjects enrolled from Japan were analyzed. Demographics, symptoms, cCTA, FFR_CT, treatment strategy, and 90-day major cardiovascular events (MACE) were assessed. Reclassification of treatment strategy between cCTA alone and cCTA+FFR_CToccurred in 55.8% of site investigations and in 56.9% in the core laboratory analysis. Patients with positive FFR (FFR_CT≤0.80) were less likely to have non-obstructive disease on invasive coronary angiography than patients with negative FFR (FFR_CT>0.80) (20.5% vs. 46.1%, P=0.0001). After FFR_CT, 67.0% of patients with positive results underwent revascularization, whereas 96.1% of patients with negative FFR_CTwere medically treated. MACE occurred in 5 patients with positive FFR_CT, but none occurred in patients with negative FFR_CTwithin 90 days.

Conclusions:In this Japanese population, FFR_CTmodified the treatment strategy in more than half of the patients. FFR_CTshowed potential for stratifying patients suspected of CAD properly into invasive or non-invasive management pathways.