Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study
Authors' conclusion
The study confirms the potential of AccuFFRct as a noninvasive alternative to invasive FFR for detecting ischemia in coronary artery disease and to risk stratify patients.
Study context
- Population
- Patients with CAD undergoing coronary computed tomography angiography (CCTA) and invasive fractional flow reserve (FFR)
- Participants
- 339 patients · 404 vessels
- Comparison
- AccuFFRct vs invasive FFR; vs CCTA and QCA
- Outcome
- Diagnostic performance for lesion-specific ischemia (invasive FFR ≤0.80 as reference)
Methodological detailsprospective
- Prospective
Performance
As reported in the abstract
Detection of lesion-specific ischemia (FFR ≤0.80)
| Test or model | AUC | Sensitivity | Specificity | PPV | NPV | Accuracy |
|---|---|---|---|---|---|---|
| AccuFFRct | 0.93 [95% CI: 0.89-0.95] | 90.9% (95% CI: 85.1%-94.9%) | 90.4% (95% CI: 86.1%-93.8%) | 85.3% (95% CI: 79.8%-89.5%) | 94.2% (95% CI: 90.8%-96.4%) | 90.6% (95% CI: 87.3%-93.3%) |
| CCTA | 0.77 [95% CI: 0.72-0.81] | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract |
| QCA | 0.89 [95% CI: 0.85-0.92] | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract |
AUC
AccuFFRct0.93 [95% CI: 0.89-0.95]
CCTA0.77 [95% CI: 0.72-0.81]
QCA0.89 [95% CI: 0.85-0.92]
Sensitivity
AccuFFRct90.9% (95% CI: 85.1%-94.9%)
CCTANot reported in the abstract
QCANot reported in the abstract
Specificity
AccuFFRct90.4% (95% CI: 86.1%-93.8%)
CCTANot reported in the abstract
QCANot reported in the abstract
PPV
AccuFFRct85.3% (95% CI: 79.8%-89.5%)
CCTANot reported in the abstract
QCANot reported in the abstract
NPV
AccuFFRct94.2% (95% CI: 90.8%-96.4%)
CCTANot reported in the abstract
QCANot reported in the abstract
Accuracy
AccuFFRct90.6% (95% CI: 87.3%-93.3%)
CCTANot reported in the abstract
QCANot reported in the abstract
- AccuFFRct vs CCTA: P < 0.001 — 0.93 vs 0.77
- AccuFFRct vs QCA: P = 0.048 — 0.93 vs 0.89
Further findings
Accuracy across subgroups (lesion classification, clinical presentation, stenosis severity, location, gray zone)
- AccuFFRct maintained high diagnostic accuracy across subgroups and in the gray zone
Rate of unnecessary invasive tests (≥70% stenosis)
- Reduced with AccuFFRct (33.1% vs 6.6%)
- P < 0.001
Original publication
Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study. JACC Cardiovasc Interv. Published 21 August 2024. doi:10.
Summarised from the published abstract; every number is checked against it