CT Fractional Flow Reserve imaging may predict which CAD patients would benefit from PCI: Study

A recent retrospective observational study has unveiled a transformative approach to managing coronary artery disease (CAD) utilizing CT fractional flow reserve (CT-FFR) analysis. The study, conducted without heart rate control, showcases the potential of this technique to significantly reduce the need for invasive procedures in patients with significant stenosis, revolutionizing the landscape of cardiac care. The study results were published in the journal Radiology: Cardiothoracic Imaging. 

Conducting CT fractional flow reserve (CT-FFR) analysis on dual-source CT scans, administered without the need for heart rate regulation, among patients presenting significant stenosis, demonstrated a notable reduction in the incidence of invasive procedures such as coronary angiography and percutaneous coronary intervention (PCI), all while maintaining safety standards. Hence, researchers conducted a retrospective observational study to analyze the clinical outcomes of CT fractional flow reserve (CT-FFR) analysis using dual-source coronary CT angiography (CTA) scans performed without heart rate control. 
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Spanning from August 2020 to August 2021, the study included all patients undergoing clinically indicated coronary CT angiography (CTA). Notably, scans were performed in the late systolic to early diastolic period without heart rate control and analyzed based on the interpreting physician’s discretion. Through meticulous chart review, researchers assessed demographic data, coronary CTA features, and clinical outcomes at 3 months post-procedure, including rates of invasive coronary angiography (ICA), percutaneous coronary intervention (PCI), myocardial infarction, and all-cause death. Out of 3098 patients undergoing coronary CTA, a subset of 292 individuals (9.7%) was referred for CT-FFR analysis.
Findings:
  • Throughout the study duration, 3098 patients underwent coronary computed tomography angiography (CTA), with 113 individuals having undergone coronary bypass grafting being excluded from the analysis.
  • Among the remaining 2985 patients, 292 (9.7%) were referred for CT fractional flow reserve (CT-FFR) analysis.
  • A small proportion, comprising two studies (0.7%), was disqualified from CT-FFR analysis, while six (2.1%) analyses did not assess the target lesion.
  • Notably, 160 patients (56.3%) exhibited CT-FFR values exceeding 0.80.
  • Among patients diagnosed with significant stenosis via coronary CTA, those who underwent CT-FFR analysis demonstrated markedly reduced rates of invasive coronary angiography (ICA) (74.5% vs 25.5%, P = .04) and percutaneous coronary intervention (PCI) (78.9% vs 21.1%, P = .05).
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The study’s findings challenge traditional approaches to CAD management, particularly in patients with significant stenosis and an average heart rate of 65 beats per minute, where heart rate control may not be deemed necessary. By leveraging dual-source coronary CTA acquisition, CT-FFR analysis emerges as a game-changing tool, guiding clinicians towards more precise and tailored treatment strategies. By harnessing the power of CT-FFR analysis, clinicians can now navigate the complexities of CAD with greater precision and confidence, sparing patients unnecessary invasive procedures while ensuring timely and effective treatment. As further research and validation efforts unfold, the widespread adoption of CT-FFR analysis promises to revolutionize the standard of care for CAD patients worldwide. 
Further reading: Randhawa, Mangun K et al. “Selective Use of CT Fractional Flow at a Large Academic Medical Center: Insights from Clinical Implementation after 1 Year of Practice.” Radiology. Cardiothoracic imaging vol. 6,2 (2024): e230073. doi:10.1148/ryct.230073
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