Relationship Between Coronary CT Angiography–Derived Fractional Flow Reserve and Clinical Outcomes in Patients With and Without Diabetes

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Conference Proceeding - Restricted Access

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Publication Title

Journal of the American College of Cardiology


Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with diabetes mellitus (DM) and is readily identified by coronary computed tomographic angiography (CTA). No studies have compared the added clinical utility of coronary CTA–derived fractional flow reserve (FFRCT) in patients with and without DM. Methods:Patients with suspected CAD, with ≥1 stenosis ≥30% on coronary CTA who underwent FFRCT, from the multicenter international ADVANCE registry, were included. Coronary CTA and FFRCT findings, treatment strategies, and clinical outcomes over 1-year follow-up were compared in patients with and without DM. Results: In total, 5,083 subjects (mean age 66 ± 10 years, 66% men, 22% with DM) were included. Subjects with DM had more obstructive CAD and multivessel CAD and proportionally more vessels with FFRCT ≤ 0.8 (Table 1). There was a similar graded increase in revascularization with declining FFRCT in both groups (Figure 1). At 1 year, DM was associated with higher rates of major adverse cardiovascular events (MACE; hazard ratio: 2.1; 95% confidence interval: 1.2-3.8; P = 0.0127). However, rates of revascularization and MACE were not significantly different for those with versus without DM when stratified by stenosis severity (<50% or ≥50%) or FFRCT positivity. Conclusion: FFRCT identifies a more complex and severe pattern of CAD in patients with DM and permits similar safe clinical integration and utility as in patients without DM.





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