Impact of Coronary CT Angiography-derived Fractional Flow Reserve on Downstream Management and Clinical Outcomes in Individuals with and without Diabetes

• Published in: Radiology. Cardiothoracic imaging Vol. 5; no. 5; p. e220276
• Main Authors: Gulsin, Gaurav S, Tzimas, Georgios, Holmes, Kenneth-Royce, Takagi, Hidenobu, Sellers, Stephanie L, Blanke, Philipp, Koweek, Lynne M H, Nørgaard, Bjarne L, Jensen, Jesper, Rabbat, Mark G, Pontone, Gianluca, Fairbairn, Timothy A, Chinnaiyan, Kavitha M, Douglas, Pamela S, Huey, Whitney, Matsuo, Hitoshi, Sand, Niels P R, Nieman, Koen, Bax, Jeroen J, Amano, Tetsuya, Kawasaki, Tomohiro, Akasaka, Takashi, Rogers, Campbell, Berman, Daniel S, Patel, Manesh R, De Bruyne, Bernard, Mullen, Sarah, Leipsic, Jonathon A
• Format: Journal Article
• Language: English
• Published: United States Radiological Society of North America 01-10-2023
• Subjects: Original Research; CT Angiography; Fractional Flow Reserve; Coronary Artery Disease; Diabetes Mellitus
• ISSN: 2638-6135; 2638-6135
• DOI: 10.1148/ryct.220276

To compare the clinical use of coronary CT angiography (CCTA)-derived fractional flow reserve (FFR) in individuals with and without diabetes mellitus (DM).
This secondary analysis included participants (enrolled July 2015 to October 2017) from the prospective, multicenter, international The Assessing Diagnostic Value of Noninvasive CT-FFR in Coronary Care (ADVANCE) registry (ClinicalTrials.gov identifier, NCT02499679) who were evaluated for suspected coronary artery disease (CAD), with one or more coronary stenosis ≥30% on CCTA images, using CT-FFR. CCTA and CT-FFR findings, treatment strategies at 90 days, and clinical outcomes at 1-year follow-up were compared in participants with and without DM.
The study included 4290 participants (mean age, 66 years ± 10 [SD]; 66% male participants; 22% participants with DM). Participants with DM had more obstructive CAD (one or more coronary stenosis ≥50%; 78.8% vs 70.6%,
< .001), multivessel CAD (three-vessel obstructive CAD; 18.9% vs 11.2%,
< .001), and proportionally more vessels with CT-FFR ≤ 0.8 (74.3% vs 64.6%,
< .001). Treatment reclassification by CT-FFR occurred in two-thirds of participants which was consistent regardless of the presence of DM. There was a similar graded increase in coronary revascularization with declining CT-FFR in both groups. At 1 year, presence of DM was associated with higher rates of major adverse cardiovascular events (hazard ratio, 2.2; 95% CI: 1.2, 4.1;
= .01). However, no between group differences were observed when stratified by stenosis severity (<50% or ≥50%) or CT-FFR positivity.
Both anatomic CCTA findings and CT-FFR demonstrated a more complex pattern of CAD in participants with versus without DM. Rates of treatment reclassification were similar regardless of the presence of DM, and DM was not an adverse prognostic indicator when adjusted for diameter stenosis and CT-FFR.Clinical trial registration no. NCT 02499679
Fractional Flow Reserve, CT Angiography, Diabetes Mellitus, Coronary Artery Disease
See also the commentary by Ghoshhajra in this issue.© RSNA, 2023.