Coronary CT-based FFR in patients with acute myocardial infarction might predict follow-up invasive FFR: The XPECT-MI study |
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Institution: | 1. Heart and Vascular Center, Semmelweis University, 68 Városmajor St, 1122, Budapest, Hungary;2. MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, 68 Városmajor St, 1122, Budapest, Hungary;3. Medical Imaging Centre, Semmelweis University, 2 Korányi St, 1083, Budapest, Hungary;4. Gottsegen National Cardiovascular Center, 29. Haller Street, 1096, Budapest, Hungary;5. St Paul''s Hospital & University of British Columbia, Department of Radiology, Burrard St, 1081, Vancouver, BC V6Z 1Y6, Canada;6. HeartFlow Inc., Redwood City, CA, USA;7. Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, 96/b Bécsi út, 1034, Budapest, Hungary |
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Abstract: | BackgroundWe aimed to evaluate whether invasive fractional flow reserve (FFRi) of non-infarction related (non-IRA) lesions changes over time in ST-elevation myocardial infarction (STEMI) patients. Moreover, we assessed the diagnostic performance of coronary CT angiography-derived FFR(FFRCT) following the index event in predicting follow-up FFRi.MethodsWe prospectively enrolled 38 STEMI patients (mean age 61.6 ± 9 years, 23.1% female) who underwent non-IRA baseline and follow-up FFRi measurements and a baseline FFRCT (within ≤10 days after STEMI). Follow-up FFRi was performed at 45–60 days (FFRi and FFRCT value of ≤0.8 was considered positive).ResultsFFRi values showed significant difference between baseline and follow-up (median and interquartile range (IQR) 0.85 0.78–0.92] vs. 0.81 0.73–0.90] p = 0.04, respectively). Median FFRCT was 0.81 0.68–0.93]. In total, 20 lesions were positive on FFRCT. A stronger correlation and smaller bias were found between FFRCT and follow-up FFRi (ρ = 0.86,p < 0.001,bias:0.01) as compared with baseline FFRi (ρ = 0.68, p < 0.001,bias:0.04). Comparing follow-up FFRi and FFRCT, no false negatives but two false positive cases were found. The overall accuracy was 94.7%, with sensitivity and specificity of 100.0% and 90.0% for identifying lesions ≤0.8 on FFRi. Accuracy, sensitivity, and specificity were 81.5%, 93.3%, and 73.9%, respectively, for identifying significant lesions on baseline FFRi using index FFRCT.ConclusionFFRCT in STEMI patients close to the index event could identify hemodynamically relevant non-IRA lesions with higher accuracy than FFRi measured at the index PCI, using follow-up FFRi as the reference standard. Early FFRCT in STEMI patients might represent a new application for cardiac CT to improve the identification of patients who benefit most from staged non-IRA revascularization. |
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Keywords: | Fractional flow reserve Coronary CT angiography Coronary CT derived fractional flow reserve Invasive fractional flow reserve Myocardial infarction Ischemic coronary lesion |
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