MDCT protocols integrating CTA and stress-rest perfusion detect functionally significant CAD with similar accuracy as CMR-Perf. Both approaches yield a very good accuracy. Integration of CTP and CTA improves MDCT performance for the detection of relevant CAD in intermediate to high pre-test probability populations.

In the preoperative assessment of patients with predominant VHD, the diagnostic accuracy of 64-slice CTA for ruling out the presence of significant coronary artery disease is very good even when including patients with irregular heart rhythm. Using this approach, CAC quantification before CTA can be successfully used to identify patients who should be referred directly to XA, sparing unnecessary exposure to radiation.

Background-Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome. Methods and Results-Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. FFR-driven change in management strategy (medical therapy, revascularization, or additional stress imaging) was assessed per-lesion and per-patient, and the agreement between final and initial strategies was recorded. Cardiovascular death, myocardial infarction, or unplanned revascularization (MACE) at 1 year was recorded. A total of 1293 lesions were evaluated in 918 patients (mean FFR, 0.81±0.1). Management plan changed in 406 patients (44.2%) and 584 lesions (45.2%). One-year MACE was 6.9%; patients in whom all lesions were deferred had a lower MACE rate (5.3%) than those with at least 1 lesion revascularized (7.3%) or left untreated despite FFR≤0.80 (13.6%; log-rank P=0.014). At the lesion level, deferral of those with an FFR≤0.80 was associated with a 3.1-fold increase in the hazard of cardiovascular death/myocardial infarction/target lesion revascularization (P=0.012). Independent predictors of target lesion revascularization in the deferred lesions were proximal location of the lesion, B2/C type and FFR. Conclusions-Routine FFR assessment of coronary lesions safely changes management strategy in almost half of the cases. Also, it accurately identifies patients and lesions with a low likelihood of events, in which revascularization can be safely deferred, as opposed to those at high risk when ischemic lesions are left untreated, thus confirming results from randomized trials. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835808. Results from the FAME 2 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2) study suggested that deferring the revascularization of epicardial stenosis with an FFR≤0.80 was associated with an 11.4% absolute increase in the risk of major cardiovascular events at 24 months (8.1% in revascularized patients versus 19.5% in medically treated), an hazard that was mainly driven by urgent revascularization. 4In spite of the overwhelming evidence of its potential clinical and economic benefits 5 and strong guideline recommendation, 6 the adoption of FFR in the real-world is perceived to vary significantly. Reasons for this disparity are several, but most operators still do rely the most on angiographic eyeballing to decide on the functional significance of coronary lesions and the need for revascularization. 7The Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease (POST-IT) was a prospective registry designed to describe the patterns of the use of FFR in an unselected real-world population, to assess its impact on clinical decis...

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Vascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.