title: Fractional flow reserve by computerized tomography and subsequent coronary revascularization.
abstract: OBJECTIVE
  Fractional flow reserve by computerized tomography (FFR-CT) provides non-invasive functional assessment of the hemodynamic significance of coronary artery stenosis. We determined the FFR-CT values, receiver operator characteristic (ROC) curves, and predictive ability of FFR-CT for actual standard of care guided coronary revascularization.
  
  
  RESULTS
  Consecutive outpatients who underwent coronary CT angiography (coronary CTA) followed by invasive angiography over a 24-month period from 2012 to 2014 were identified. Studies that fit inclusion criteria (n = 75 patients, mean age 66, 75% males) were sent for FFR-CT analysis, and results stratified by coronary artery calcium (CAC) scores. Coronary CTA studies were re-interpreted in a blinded manner, and baseline FFR-CT values were obtained retrospectively. Therefore, results did not interfere with clinical decision-making. Median FFR-CT values were 0.70 in revascularized (n = 69) and 0.86 in not revascularized (n = 138) coronary arteries (P < 0.001). Using clinically established significance cut-offs of FFR-CT ≤0.80 and coronary CTA ≥70% stenosis for the prediction of clinical decision-making and subsequent coronary revascularization, the positive predictive values were 74 and 88% and negative predictive values were 96 and 84%, respectively. The area under the curve (AUC) for all studied territories was 0.904 for coronary CTA, 0.920 for FFR-CT, and 0.941 for coronary CTA combined with FFR-CT (P = 0.001). With increasing CAC scores, the AUC decreased for coronary CTA but remained higher for FFR-CT (P < 0.05).
  
  
  CONCLUSIONS
  The addition of FFR-CT provides a complementary role to coronary CTA and increases the ability of a CT-based approach to identify subsequent standard of care guided coronary revascularization.
authors.affiliation: Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA rpackard@mednet.ucla.edu.|Department of Molecular, Cellular, and Integrative Physiology, UCLA, Los Angeles, CA, USA.|David Geffen School of Medicine at University of California, 650 Charles E. Young Dr. South, A2-237 CHS, Los Angeles, CA 90095, USA.|Cardiovascular Research Foundation of Southern California, Los Angeles, CA, USA.
authors.forename: René R Sevag
authors.initials: RR
authors.lastname: Packard
authors.affiliation: David Geffen School of Medicine at University of California, 650 Charles E. Young Dr. South, A2-237 CHS, Los Angeles, CA 90095, USA.|Los Angeles Biomedical Research Institute, Torrance, CA, USA.|Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA.
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.affiliation: David Geffen School of Medicine at University of California, 650 Charles E. Young Dr. South, A2-237 CHS, Los Angeles, CA 90095, USA.|Los Angeles Biomedical Research Institute, Torrance, CA, USA.|Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: David Geffen School of Medicine at University of California, 650 Charles E. Young Dr. South, A2-237 CHS, Los Angeles, CA 90095, USA.|Cardiovascular Research Foundation of Southern California, Los Angeles, CA, USA.|Cedars Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Karlsberg
mesh_terms: D000368:Aged; D019540:Area Under Curve; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D016001:Confidence Intervals; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: coronary computerized tomography angiography; coronary revascularization; fractional flow reserve by computerized tomography