Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(5), 494–501. https://doi.org/10.1002/clc.23989 Dr. Shinichi Wada et al.
Points
- A nationwide study of 1187 patients with suspected coronary artery disease (CAD) evaluated the predictive value of Fractional Flow Reserve by Coronary Computed Tomography Angiography (FFRCT) for Major Adverse Cardiovascular Events (MACE).
- Among patients with ≥50% coronary artery stenosis (CAS), the incidence rate of MACE was significantly higher (6.11 per 100 patient-year) compared to those without CAS (1.16 per 100 patient-year), highlighting CAS as a strong predictor of adverse cardiovascular outcomes.
- FFRCT, diabetes mellitus, and low high-density lipoprotein (HDL) cholesterol levels were independently associated with incident MACE in patients with CAS, with lower FFRCT values indicating increased risk.
- Patients harboring all three risk factors (lower FFRCT, diabetes mellitus, and low HDL cholesterol) had a significantly higher hazard ratio for MACE (6.01) compared to those with 0-2 of these factors.
- The study emphasizes the importance of a comprehensive assessment approach that combines coronary CT angiography (CCTA), FFRCT, and the consideration of relevant risk factors for more accurate prediction of MACE in patients with suspected CAD, aiding clinical risk stratification.
Summary
In this nationwide multicenter prospective cohort study, encompassing 1187 patients aged 50−74 years with suspected coronary artery disease (CAD), researchers aimed to evaluate the predictive capacity of fractional flow reserve determined with coronary computed tomography angiography (FFRCT) for major adverse cardiovascular events (MACE). Those with a suspected CAD diagnosis and available coronary CT angiography (CCTA) data were included among these patients. FFRCT analysis was performed on patients exhibiting ≥50% coronary artery stenosis (CAS), and the study utilized the Cox proportional hazards model to assess the relationship between FFRCT, cardiovascular risk factors, and the occurrence of MACE within a 2-year timeframe.
Of the 933 patients with available MACE information within two years post-enrollment, the incidence rate of MACE was notably higher in the subgroup of 281 patients with CAS compared to those without CAS (6.11 vs. 1.16 per 100 patient-year). This substantial difference in MACE incidence highlights the clinical relevance of CAS in predicting adverse cardiovascular outcomes.
Subsequent analysis involving the 241 CAS patients revealed that FFRCT, diabetes mellitus, and low high-density lipoprotein (HDL) cholesterol levels exhibited independent associations with incident MACE. Specifically, patients with lower FFRCT values were at heightened risk, underlining the importance of FFRCT as a predictive tool in CAD management. Furthermore, diabetes mellitus and low HDL cholesterol levels emerged as significant contributors to MACE risk, reinforcing their roles as critical risk factors.
Moreover, the hazard ratio for MACE was significantly higher in patients harboring all three risk factors—lower FFRCT, diabetes mellitus, and low HDL cholesterol levels—compared to those possessing 0−2 of these risk factors (6.01; 95% confidence interval: 2.77−13.03). This compelling data underscores the synergistic effect of these risk factors in elevating the likelihood of MACE occurrence, demonstrating the value of multifactorial risk assessment in CAD management.
In conclusion, the study underscores the utility of a comprehensive assessment approach that combines CCTA for stenosis evaluation, FFRCT measurement, and considering pertinent risk factors. This approach enhances the accuracy of MACE prediction among patients with suspected CAD. Notably, among individuals with CAS, those with lower FFRCT values, diabetes mellitus, and reduced HDL cholesterol levels face the highest risk of experiencing MACE over a 2-year follow-up period, providing valuable insights for clinical risk stratification in this population.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.23989
References Wada, S., Iwanaga, Y., Nakai, M., Nakao, Y. M., Miyamoto, Y., Noguchi, T., & for The NADESICO Study Investigators. (2023). Combination of coronary CT angiography, FFR CT , and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD. Clinical Cardiology, 46(5), 494–501. https://doi.org/10.1002/clc.23989
