FFR_CT and Static Computed Tomography Myocardial Perfusion Imaging for Therapeutic Decision-making and Prognosis in Patients With Coronary Artery Disease

Purpose: The purpose of this study was to investigate the effect of integrated evaluation of resting static computed tomography perfusion (CTP) and coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) on therapeutic decision-making and predicting major adverse cardiovascular events (MACEs) in patients with suspected coronary artery disease. Materials and Methods: In this post hoc analysis of a prospective trial of CCTA in patients assigned to either CCTA or CCTA plus FFRCT arms, 500 patients in the CCTA plus FFRCT arm were analyzed. Both resting static CTP and FFRCT were evaluated by using the conventional CCTA. Perfusion defects in the myocardial segments with >= 50% degree of stenosis in the supplying vessels were defined as resting static CTP positive, and any vessel with an FFRCT value of <= 0.80 was considered positive. Patients were divided into 3 groups: (1) negative CTP-FFRCT match group (resting static CTP-negative and FFRCT-negative group); (2) mismatch CTP-FFRCT group (resting static CTP-positive and FFRCT-negative or resting static CTP-negative and FFRCT-positive group); and (3) positive CTP-FFRCT match group (resting static CTP-positive and FFRCT-positive group). We compared the revascularization-to-invasive coronary angiography ratio and the MACE rate among 3 subgroups at 1- and 3-year follow-ups. The adjusted Cox hazard proportional model was used to assess the prognostic value of FFRCT and resting static CTP to determine patients at risk of MACE. Results: Patients in the positive CTP-FFRCT match group were more likely to undergo revascularization at the time of invasive coronary angiography compared with those in the mismatch CTP-FFRCT group (81.4% vs 57.7%, P=0.033) and the negative CTP-FFRCT match group (81.4% vs 33.3%, P=0.001). At 1- and 3-year follow-ups, patients in the positive CTP-FFRCT match group were more likely to have MACE than those in the mismatch CTP-FFRCT group (10.5% vs 4.2%, P=0.046; 35.6% vs 9.4%, P<0.001) and the negative CTP-FFRCT match group (10.5% vs 0.9%, P<0.001; 35.6% vs 5.4%, P<0.001). A positive CTP-FFRCT match was strongly related to MACE at 1-year (hazard ratio=8.06, P=0.003) and 3-year (hazard ratio=6.23, P<0.001) follow-ups. Conclusion: In patients with suspected coronary artery disease, the combination of FFRCT with resting static CTP could guide therapeutic decisions and have a better prognosis with fewer MACE in a real-world scenario.