Incidence and predictors of lesion-specific ischemia by FFRCT: Learnings from the international ADVANCE registry

Hironori Kitabata, Wakayama Medical University
Jonathon Leipsic, The University of British Columbia
Manesh R. Patel, Duke University School of Medicine
Koen Nieman, Erasmus MC
Bernard De Bruyne, Onze Lieve Vrouw Hospital
Campbell Rogers, HeartFlow, Inc.
Gianluca Pontone, Università degli Studi di Milano
Bjarne L. Nørgaard, Aarhus Universitetshospital
Jeroen J. Bax, Leiden University Medical Center - LUMC
Gilbert Raff, William Beaumont Hospital
Kavitha M. Chinnaiyan, William Beaumont Hospital
Mark Rabbat, Loyola University Medical Center
Niels Peter Rønnow Sand, Syddansk Universitet
Philipp Blanke, The University of British Columbia
Timothy A. Fairbairn, Liverpool Heart and Chest Hospital
Hitoshi Matsuo, Gifu Heart Center
Tetsuya Amano, Aichi Medical University
Tomohiro Kawasaki, Shin-Koga Hospital
Yoshihiro Morino, Iwate Medical University
Takashi Akasaka, Wakayama Medical University


© 2018 Society of Cardiovascular Computed Tomography Background: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry. Methods: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFRCT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFRCT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFRCT. Results: FFRCT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFRCT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFRCT than those with <3 risk factors>(60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04–2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14–2.14, p = 0.005) were both predictive of abnormal FFRCT. In addition, >70% stenosis was significantly associated with low FFRCT (OR 31.16, 95%CI 12.25–79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30–49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52–9.17, p < 0.0001). Conclusions: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFRCT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.