Distribution of FFRCT in Single Obstructive Coronary Stenosis and Predictors for Major Adverse Cardiac Events: A Propensity Score Matching Study

Abstract

Background: Fractional flow reserve derived from computed tomography (FFRCT) has been demonstrated significantly improved identification of lesion-specific ischemia compared with coronary computed tomography angiography (CCTA). It remains unclear the distribution of FFRCT values in obstructive stenosis between patients who received percutaneous coronary intervention (PCI) or not in routine clinical practice, as well as its association with clinical outcome. This study aims to reveal the distribution of FFRCT value in patients with single obstructive coronary artery stenosis, and explored the independent factors for predicting major adverse cardiac events (MACE). Methods: This was a retrospective study of adults with non-ST-segment elevation acute coronary syndrome undergoing FFRCT assessment by using CCTA data from January 1, 2016 to December 31, 2020. Propensity score matching (PSM) method was used to account for patient selection bias. The risk factors for predicting MACE were evaluated by a Cox proportional hazards regression analysis. Results: Overall, 655 patients with single obstructive (³ 50%) stenosis shown on CCTA were enrolled and divided into PCI group (376 cases) and conservative group (279 cases) according to treatment. The PSM cohort analysis demonstrated that the difference in history of unstable angina, CCSC and FFRCT between PCI group (188 cases) and conservative group (315 cases) was statistically significant, with all P values < 0.05, while the median follow-up time between them was no statistically significant (24 months vs 22.5months, P = 0.912). The incidence of MACE in PCI group and conservative group were 14.9% (28/188) and 23.5% (74/315) respectively, P = 0.020. Multivariate analysis of Cox proportional hazards regression revealed that history of unstable angina (adjusted odds ratio (adjOR), 3.165; 95% confidence interval (CI), 2.087-4.800; P < 0.001), FFRCT £ 0.8 (OR, 1.632;95% CI, 1.095-2.431; P = 0.016), and PCI therapy (OR, 0.481; 95% CI, 0.305-0.758) were the independent factors for MACE. Conclusions: History of unstable angina and FFRCT value of £ 0.8 were the independent risk factors for MACE, while PCI therapy was the independent protective factor for MACE.

To Explore the Influencing Factors of Pericoronary Adipose Tissue and Noninvasive Fractional Flow Reserve on the Progression of Coronary Heart Disease Based on 320-Slice Coronary CTA

“…4 , 5 Moreover, the difference of FFR CT before and after coronary stenosis ( Δ FFR CT ) has certain value in predicting the occurrence and development of acute coronary syndrome, which may provide additional information compared with FFR CT . 6 - 8 However, whether PCAT parameters and noninvasive hemodynamic characteristics are related to the development of CAD remains to be unclear. Therefore, this study focuses on PCAT volume, PCAT-fat attenuation index (FAI), FFR CT , and Δ FFR CT to explore the relationship between PCAT parameters and noninvasive hemodynamic characteristic parameters and the development of CAD, so as to provide a new idea for predicting the development of CAD.…”