Clinical impact of coronary computed tomography angiography-derived fractional flow reserve on Japanese population in the ADVANCE registry
Background: Coronary computed tomography angiography (cCTA)-derived fractional flow reserve (FFRCT) is a promising diagnostic method for the evaluation of coronary artery disease (CAD). However, clinical data regarding FFRCTin Japan are scarce, so we assessed the clinical impact of using FFRCTin a Japanese population.Methods and Results:The ADVANCE registry is an international prospective FFRCTregistry of patients suspected of CAD. Of 5,083 patients, 1,829 subjects enrolled from Japan were analyzed. Demographics, symptoms, cCTA, FFRCT, treatment strategy, and 90-day major cardiovascular events (MACE) were assessed. Reclassification of treatment strategy between cCTA alone and cCTA+FFRCToccurred in 55.8% of site investigations and in 56.9% in the core laboratory analysis. Patients with positive FFR (FFRCT≤0.80) were less likely to have non-obstructive disease on invasive coronary angiography than patients with negative FFR (FFRCT>0.80) (20.5% vs. 46.1%, P=0.0001). After FFRCT, 67.0% of patients with positive results underwent revascularization, whereas 96.1% of patients with negative FFRCTwere medically treated. MACE occurred in 5 patients with positive FFRCT, but none occurred in patients with negative FFRCTwithin 90 days.
Shiono Y, Matsuo H, Kawasaki T, Amano T, Kitabata H, Kubo T, Morino Y, Yoda S, Sakamoto T, Ito H, Shite J, Otake H, Tanaka N, Terashima M, Kadota K, Patel MR, Nieman K, Rogers C, Nørgaard BL, Bax JJ, Raff GL, Chinnaiyan KM, Berman DS, Fairbairn TA, Hurwitz Koweek LM, Leipsic J, Akasaka T. Clinical Impact of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve on Japanese Population in the ADVANCE Registry. Circ J. 2019 May 24;83(6):1293-1301. doi: 10.1253/circj.CJ-18-1269. Epub 2019 Apr 18. PMID: 30996150.