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CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard.
JACC Cardiovasc Imaging. 2016 05; 9(5):559-64.JC

Abstract

OBJECTIVES

The goal of this study was to compare the diagnostic performance of coronary computed tomography angiography (CTA) versus quantitative coronary angiography (QCA) for the detection of lesion-specific ischemia using fractional flow reserve (FFR) as the gold standard.

BACKGROUND

Coronary CTA has emerged as a noninvasive method for accurate detection and exclusion of high-grade coronary stenoses. FFR is the gold standard for determining lesion-specific ischemia and has been shown to improve clinical outcomes when guiding revascularization.

METHODS

A total of 252 patients from 5 countries were prospectively enrolled (mean age 63 years; 71% male). Patients underwent coronary CTA and invasive coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and FFR were interpreted by independent core laboratories. Stenosis severity according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%, 50% to 69%, and 70% to 100%; stenosis ≥50% was considered anatomically obstructive. Lesion-specific ischemia was defined according to FFR ≤0.8, whereas QCA and coronary CTA stenosis ≥50% were considered obstructive. Diagnostic accuracy and areas under the receiver-operating characteristics curve (AUC) for lesion-specific ischemia was assessed.

RESULTS

According to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for QCA (p = 0.6). No differences between CTA and QCA existed for discrimination of ischemia within the left anterior descending artery (AUC 0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p = 0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6).

CONCLUSIONS

CTA and ICA exhibited similar diagnostic performance for the detection and exclusion of lesion-specific ischemia. Using a true reference standard to determine appropriate revascularization targets, 3-dimensional coronary CTA performed as well as 2-dimensional ICA.

Authors+Show Affiliations

Department of Medicine, Los Angeles Biomedical Research Center, Torrance, California. Electronic address: mbudoff@labiomed.org.Cedars-Sinai Heart Institute and Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.Cedars-Sinai Heart Institute and Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.Cedars-Sinai Heart Institute and Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

26897669

Citation

Budoff, Matthew J., et al. "CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard." JACC. Cardiovascular Imaging, vol. 9, no. 5, 2016, pp. 559-64.
Budoff MJ, Nakazato R, Mancini GB, et al. CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard. JACC Cardiovasc Imaging. 2016;9(5):559-64.
Budoff, M. J., Nakazato, R., Mancini, G. B., Gransar, H., Leipsic, J., Berman, D. S., & Min, J. K. (2016). CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard. JACC. Cardiovascular Imaging, 9(5), 559-64. https://doi.org/10.1016/j.jcmg.2015.08.021
Budoff MJ, et al. CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard. JACC Cardiovasc Imaging. 2016;9(5):559-64. PubMed PMID: 26897669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT Angiography for the Prediction of Hemodynamic Significance in Intermediate and Severe Lesions: Head-to-Head Comparison With Quantitative Coronary Angiography Using Fractional Flow Reserve as the Reference Standard. AU - Budoff,Matthew J, AU - Nakazato,Ryo, AU - Mancini,G B John, AU - Gransar,Heidi, AU - Leipsic,Jonathon, AU - Berman,Daniel S, AU - Min,James K, Y1 - 2016/02/17/ PY - 2015/06/02/received PY - 2015/07/30/revised PY - 2015/08/05/accepted PY - 2016/2/22/entrez PY - 2016/2/22/pubmed PY - 2017/10/25/medline KW - coronary CT KW - coronary angiography KW - diagnostic accuracy KW - fractional flow reserve KW - multidetector computed tomography SP - 559 EP - 64 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 9 IS - 5 N2 - OBJECTIVES: The goal of this study was to compare the diagnostic performance of coronary computed tomography angiography (CTA) versus quantitative coronary angiography (QCA) for the detection of lesion-specific ischemia using fractional flow reserve (FFR) as the gold standard. BACKGROUND: Coronary CTA has emerged as a noninvasive method for accurate detection and exclusion of high-grade coronary stenoses. FFR is the gold standard for determining lesion-specific ischemia and has been shown to improve clinical outcomes when guiding revascularization. METHODS: A total of 252 patients from 5 countries were prospectively enrolled (mean age 63 years; 71% male). Patients underwent coronary CTA and invasive coronary angiography (ICA) with FFR in 407 lesions. Coronary CTA, QCA, and FFR were interpreted by independent core laboratories. Stenosis severity according to coronary CTA and QCA were graded as 0% to 29%, 30% to 49%, 50% to 69%, and 70% to 100%; stenosis ≥50% was considered anatomically obstructive. Lesion-specific ischemia was defined according to FFR ≤0.8, whereas QCA and coronary CTA stenosis ≥50% were considered obstructive. Diagnostic accuracy and areas under the receiver-operating characteristics curve (AUC) for lesion-specific ischemia was assessed. RESULTS: According to FFR, ischemia was present in 151 (37%) of 407 lesions. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 79%, 63%, 55%, and 83% for coronary CTA; and 71%, 74%, 70%, 59%, and 82% for QCA. AUC for identification of ischemia-causing lesions was similar: 0.75 for coronary CTA and 0.77 for QCA (p = 0.6). No differences between CTA and QCA existed for discrimination of ischemia within the left anterior descending artery (AUC 0.71 vs. 0.73; p = 0.6), left circumflex artery (AUC 0.78 vs. 0.85; p = 0.4), and right coronary artery (AUC 0.80 vs. 0.83; p = 0.6). CONCLUSIONS: CTA and ICA exhibited similar diagnostic performance for the detection and exclusion of lesion-specific ischemia. Using a true reference standard to determine appropriate revascularization targets, 3-dimensional coronary CTA performed as well as 2-dimensional ICA. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/26897669/CT_Angiography_for_the_Prediction_of_Hemodynamic_Significance_in_Intermediate_and_Severe_Lesions:_Head_to_Head_Comparison_With_Quantitative_Coronary_Angiography_Using_Fractional_Flow_Reserve_as_the_Reference_Standard_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(15)00973-0 DB - PRIME DP - Unbound Medicine ER -