Fay Nous1, Ricardo P J Budde2, Timothy A Fairbairn3, Takashi Akasaka4, Bjarne L Nørgaard5, Daniel S Berman6, Gilbert Raff7, Lynne M Hurwitz-Koweek8, Gianluca Pontone9, Tomohiro Kawasaki10, Niels Peter R Sand11, Jesper M Jensen12, Tetsuya Amano13, Michael Poon14, Kristian A Øvrehus15, Jeroen Sonck16, Mark G Rabbat17, Sarah Mullen18, Bernard De Bruyne19, Campbell Rogers20, Hitoshi Matsuo21, Jeroen J Bax22, Jonathon Leipsic23, Manesh R Patel24, Koen Nieman25. 1. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: f.nous@erasmusmc.nl. 2. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: r.budde@erasmusmc.nl. 3. Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, United Kingdom. Electronic address: timothy.fairbairn@lhch.nhs.uk. 4. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. Electronic address: akasat@wakayama-med.ac.jp. 5. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: bnorgaard@dadlnet.dk. 6. Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA. Electronic address: daniel.berman@cshs.org. 7. Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA. Electronic address: gilbert.raff@beaumont.edu. 8. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. Electronic address: lynne.koweek@duke.edu. 9. Centro Cardiologico Monzino, IRCCS, Milan, Italy. Electronic address: gianluca.pontone@cardiologicomonzino.it. 10. Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan. Electronic address: to-kawasaki@mug.biglobe.ne.jp. 11. Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark. Electronic address: npsand@webspeed.dk. 12. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: jespejns@rm.dk. 13. Department of Cardiology, Aichi Medical University, Aichi, Japan. Electronic address: amanot@aichi-med-u.ac.jp. 14. Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA. Electronic address: mpoon1@northwell.edu. 15. Department of Cardiology, Odense University Hospital, Denmark. Electronic address: kristian.altern.ovrehus@rsyd.dk. 16. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. Electronic address: jeroensonck@icloud.com. 17. Division of Cardiology, Loyola University Chicago, Chicago, IL, USA. Electronic address: mrabbat@lumc.edu. 18. HeartFlow Inc., Redwood City, CA, USA. Electronic address: smullen@heartflow.com. 19. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. Electronic address: bernard.de.bruyne@olvz-aalst.be. 20. HeartFlow Inc., Redwood City, CA, USA. Electronic address: crogers@heartflow.com. 21. Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan. Electronic address: matsuo@heart-center.or.jp. 22. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: j.j.bax@lumc.nl. 23. Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. Electronic address: jleipsic@providencehealth.bc.ca. 24. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. Electronic address: manesh.patel@duke.edu. 25. Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA. Electronic address: knieman@stanford.edu.
Abstract
BACKGROUND: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFRCT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFRCT within the ADVANCE registry. METHODS: 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FFRCT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles. RESULTS: The number of patients with a ≥70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1-3). The rate of positive FFRCT ≤0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFRCT ≤0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts. CONCLUSIONS: Growing experience with FFRCT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFRCT.
BACKGROUND: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFRCT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFRCT within the ADVANCE registry. METHODS: 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FFRCT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles. RESULTS: The number of patients with a ≥70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1-3). The rate of positive FFRCT ≤0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFRCT ≤0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts. CONCLUSIONS: Growing experience with FFRCT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFRCT.