title: FFR Derived From Coronary CT Angiography in Nonculprit Lesions of Patients With Recent STEMI.
abstract: This study sought to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) for the diagnosis of lesion-specific ischemia in nonculprit vessels of patients with recent in ST-segment elevation myocardial infarction (STEMI).
  
  
  
  In patients with stable angina, FFRCThas high diagnostic performance in identification of ischemia-causing lesions. The potential value of FFRCTfor assessment of multivessel disease in patients with recent STEMI has not been evaluated.
  
  
  
  Coronary CTA with calculation of FFRCTand invasive coronary angiography with FFR were performed 1 month after STEMI in patients with multivessel disease. Coronary CTA and invasive coronary angiography stenosis >50% were considered obstructive. Lesion-specific ischemia was assumed if FFRCTwas ≤0.80. FFR ≤0.80 was the reference standard. To evaluate the influence of vessel size, the total coronary vessel lumen volume relative to left ventricular mass (volume-to-mass ratio) was calculated and compared with that of patients with stable angina.
  
  
  
  The study evaluated 124 nonculprit vessels from 60 patients. Accuracy, sensitivity, and specificity of FFRCTwere 72%, 83%, and 66% versus 64% (p = 0.033), 93% (p = 0.15), and 49% (p < 0.001) for CTA and 72% (p = 1.00), 76% (p = 0.46), and 70% (p = 0.54) for invasive coronary angiography. Following STEMI, median volume-to-mass ratio was lower than in patients with stable angina, 53 versus 65 mm3/g (p = 0.009). In patients with volume-to-mass ratio ≥65 mm3/g (upper tertile) accuracy, sensitivity, and specificity of FFRCTwere all 83% versus 56% (p = 0.009), 75% (p = 0.61), and 44% (p = 0.003) in patients with <49 mm3/g (lower tertile).
  
  
  
  The diagnostic performance of FFRCTfor staged detection of ischemia in STEMI patients with multivessel disease is moderate. STEMI patients have a smaller vessel volume than do patients with stable angina. The diagnostic performance of FFRCTis influenced by the volume-to-mass ratio. This study does not support routine use of FFRCTin the post-STEMI setting. (Assessment of Coronary Stenoses Using Coronary CT-Angiography and Noninvasive Fractional Flow Reserve; NCT01739075).
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: saga@clin.au.dk.
authors.forename: Sara
authors.initials: S
authors.lastname: Gaur
authors.affiliation: HeartFlow, Inc., Redwood City, California; Department of Bioengineering, Stanford University, Stanford, California.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Taylor
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jesper M
authors.initials: JM
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Evald H
authors.initials: EH
authors.lastname: Christiansen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Kaltoft
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Niels R
authors.initials: NR
authors.lastname: Holm
authors.affiliation: Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: HeartFlow, Inc., Redwood City, California; Department of Surgery, Stanford University, Stanford, California.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Zarins
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: HeartFlow, Inc., Redwood City, California.
authors.forename: Sophie
authors.initials: S
authors.lastname: Khem
authors.affiliation: HeartFlow, Inc., Redwood City, California.
authors.forename: Alan
authors.initials: A
authors.lastname: Wilk
authors.affiliation: Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, Ohio.
authors.forename: Hiram G
authors.initials: HG
authors.lastname: Bezerra
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Lassen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Nørgaard
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
keywords: ST-segment elevation myocardial infarction; coronary computed tomography angiography; fractional flow reserve; nonculprit lesion