Combination of coronary CT angiography, FFR_CT, and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD

Abstract

Background To examine the utility of fractional flow reserve by coronary computed tomography (CT) angiography (FFRCT) for predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD). Methods This was a nationwide multicenter prospective cohort study including consecutive 1187 patients aged 50−74 years with suspected CAD and had available coronary CT angiography (CCTA). In patients with ≥50% coronary artery stenosis (CAS), FFRCT was further analyzed. The Cox proportional hazards model was used to examine the association of FFRCT and cardiovascular risk factors with incident MACE within 2 years. Results Among 933 patients with available information on MACE within 2 years after enrollment, the incidence rate of MACE was higher in 281 patients with CAS than in those without CAS (6.11 vs. 1.16 per 100 patient‐year). In 241 patients with CAS, the Cox proportional hazards analysis showed that FFRCT as well as diabetes mellitus and low high‐density lipoprotein cholesterol level were independently associated with incident MACE. Moreover, the hazard ratio was significantly higher in patients harboring all three factors compared to those harboring 0−2 of the three factors (6.01; 95% confidence interval: 2.77−13.03). Conclusions Combinatorial assessment using CCTA for stenosis, FFRCT, and risk factors was useful for more accurate prediction of MACE in patients with suspected CAD. Among patients with CAS, those with lower FFRCT, diabetes mellitus, and low high‐density lipoprotein cholesterol level were at highest risk for MACE during the 2‐year period following enrollment.

Evaluation of functional significance of coronary arteries stenoses with estimation of fractional flow reserve based on computed tomography angiography data

“…У 241 пациента со стенозами КА ≥50% и рассчитанным ФРК КТ анализ пропорциональных рисков показал, что более низкий показатель ФРК КТ так же, как сахарный диабет и низкий уровень липопротеидов высокой плотности, связан с частотой развития нежелательных сердечно-сосудистых событий. У пациентов с наличием всех трех факторов отношение рисков выше, чем у пациентов с 0-2 факторами (ОР-95% ДИ 2,77-13,03) [18]. Авторы другого исследования [19] изучали прогностическую ценность расчета ФРК КТ за 3-летний период наблюдения у пациентов, включенных в ADVANCE registry [20].…”

A Pilot Study on the Association between Cardiovascular Risk Factors and Coronary Artery Calcification in a Group of Patients Investigated via Cardiac Computed Tomography in a European Country with High Cardiovascular Risk

“…Overall, the findings are consistent with findings in the scientific literature. For instance, Wada et al also found that patients diagnosed with coronary stenosis via CCTA were older, current or past smokers who had hypertension or diabetes; the difference was the association with the male sex and low levels of HDL and total cholesterol in the context of higher rates of statin use [22]. Kaolawanich et al found that high CAC >400 was significantly associated with hypertension [2].…”

“…To date, several studies have established the association of CAC with conventional cardiovascular disease risk factors and have also evaluated risk prediction models, biological markers, and imaging means of CVD screening [1,13,15,20,21]. Patients with more risk factors, for example, three factors compared to zero, one, or two, also had higher CAC scores; moreover, CAC has been reported to be an independent predictor of CAD risk [1,13,15,22].…”