TY - JOUR
T1 - Prognostic Value of Computed Tomography-Derived Fractional Flow Reserve Comparison With Myocardial Perfusion Imaging
AU - Ahmed, Ahmed Ibrahim
AU - Han, Yushui
AU - Al Rifai, Mahmoud
AU - Alnabelsi, Talal
AU - Nabi, Faisal
AU - Chang, Su Min
AU - Cocker, Myra
AU - Schwemmer, Chris
AU - Ramirez-Giraldo, Juan C.
AU - Kleiman, Neal S.
AU - Zoghbi, William A.
AU - Mahmarian, John J.
AU - Al-Mallah, Mouaz H.
N1 - Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - OBJECTIVES: The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes.BACKGROUND: SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease.METHODS: We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment.RESULTS: A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses.CONCLUSIONS: In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.
AB - OBJECTIVES: The aim of this study was to compare the incremental prognostic value of coronary computed tomography (CT) angiography (CCTA)-derived machine learning fractional flow reserve CT (ML-FFRct) versus that of ischemia detected on single-photon emission-computed tomography (SPECT) myocardial perfusion imaging (MPI) on incident cardiovascular outcomes.BACKGROUND: SPECT MPI and ML-FFRct are noninvasive tools that can assess the hemodynamic significance of coronary atherosclerotic disease.METHODS: We studied a retrospective cohort of consecutive patients who underwent clinically indicated CCTA and SPECT MPI. ML-FFRct was computed using a ML prototype. The primary outcome was all-cause mortality and nonfatal myocardial infarction (D/MI), and the secondary outcome was D/MI and unplanned revascularization, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) occurring more than 90 days postimaging. Multiple nested multivariate cox regression was used to model a scenario wherein an initial anatomical assessment was followed by a functional assessment.RESULTS: A total of 471 patients (mean age: 64 ± 13 year; 53% males) were included. Comorbidities were prevalent (78% hypertension, 66% diabetes, 81% dyslipidemia). ML-FFRct was <0.8 in at least 1 proximal/midsegment was present in 41.6% of patients, and ischemia on MPI was present in 13.8%. After a median follow-up of 18 months, 7% of patients (n = 33) experienced D/MI. On multivariate Cox proportional analysis, the presence of ischemia on MPI but not ML-FFRct significantly predicted D/MI (HR: 2.3; 95% CI: 1.0-5.0; P = 0.047; or HR: 0.7; 95% CI: 0.3-1.4; P = 0.306 respectively) when added to CCTA obstructive stenosis. Furthermore, the model with SPECT ischemia had higher global chi-square result and significantly improved reclassification. Results were similar using the secondary outcome and on several sensitivity analyses.CONCLUSIONS: In a high-risk patient cohort, SPECT MPI but not ML-FFRct adds independent and incremental prognostic information to CCTA-based anatomical assessment and clinical risk factors in predicting incident outcomes.
KW - CCTA
KW - ML-FFRct
KW - SPECT
KW - Predictive Value of Tests
KW - Myocardial Perfusion Imaging/methods
KW - Prognosis
KW - Computed Tomography Angiography/methods
KW - Humans
KW - Middle Aged
KW - Male
KW - Tomography, X-Ray Computed
KW - Coronary Artery Disease/diagnostic imaging
KW - Fractional Flow Reserve, Myocardial
KW - Female
KW - Aged
KW - Retrospective Studies
KW - Coronary Angiography/methods
KW - Percutaneous Coronary Intervention
UR - http://www.scopus.com/inward/record.url?scp=85119108980&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85119108980&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2021.09.007
DO - 10.1016/j.jcmg.2021.09.007
M3 - Article
C2 - 34656489
AN - SCOPUS:85119108980
SN - 1936-878X
VL - 15
SP - 284
EP - 295
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 2
ER -