Usefulness of FFR-CT to exclude haemodynamically significant lesions in high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS)
Authors' conclusion
In patients with high-risk NSTE-ACS, FFR-CT offers better diagnostic accuracy - though not statistically significant - and a higher ability to rule out haemodynamically significant stenoses as compared to CCTA. This indicates that FFR-CT can reduce unnecessary invasive procedures by more accurately identifying patients requiring further intervention.
Study context
- Population
- High-risk NSTE-ACS patientsof 250 initially planned, 151 (92%) had sufficient coronary computed tomography angiography (CCTA) image quality for CCTA and FFR-CT analysis
- Participants
- 168 patients
- Exposure
- FFR-CT and CCTA against invasive coronary angiography (ICA) with invasive fractional flow reserve (FFR) as the gold standard
- Outcome
- Diagnostic performance, patient level
Methodological details4 European centres
- 4 European centres
Main finding
As reported in the abstract
| Group | Sensitivity | Specificity | Positive predictive value | Negative predictive value | Accuracy |
|---|---|---|---|---|---|
| FFR-CT | 94% | 63% | 83% | 85% | 83% |
| CCTA | 93% | 54% | 79% | 80% | 79% |
Sensitivity
FFR-CT94%
CCTA93%
Specificity
FFR-CT63%
CCTA54%
Positive predictive value
FFR-CT83%
CCTA79%
Negative predictive value
FFR-CT85%
CCTA80%
Accuracy
FFR-CT83%
CCTA79%
- FFR-CT vs CCTA: P = 0.58 — numerically higher with FFR-CT, not statistically significant
Observational data: associations, not effects.
Further findings
Receiver operating characteristic curves
| Outcome | FFR-CT | CCTA | P value |
|---|---|---|---|
| Detection of significant lesions, lesion level (receiver operating characteristic curves)Significantly better with FFR-CT | 0.84 | 0.65 | P < 0.01 |
High-sensitivity troponin T at 1 hour post-hospitalisation
- Median, times the upper reference limit (interquartile range: 1.8-18.6)
- 5.3
Original publication
Usefulness of FFR-CT to exclude haemodynamically significant lesions in high-risk NSTE-ACS. EuroIntervention. Published 6 January 2025. doi:10.
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