Gabara, Lavinia, Hinton, Jonathan, Kira, Mohamed, Saunders, Alec, Shambrook, James, Abbas, Ausami, Leipsic, Jonathon A., Rogers, Campbell, Mullen, Sarah, Ng, Nicholas, Wilding, Sam, Douglas, Pamela S., Patel, Manesh, Fairbairn, Timothy A., Hlatky, Mark A. and Curzen, Nick (2024) Derivation and validation of a novel functional FFRCT score incoporating the burden of coronary stensosis severity and flow impairment to predict clinical events. Journal of Cardiovascular Computed Tomography, 18 (1), 33-42. (doi:10.1016/j.jcct.2023.10.005).
Abstract
Background: a score combining the burden of stenosis severity on coronary computed tomography angiography (CCTA) and flow impairment by fractional flow reserve derived from computed tomography (FFRCT) may be a better predictor of clinical events than either parameter alone.
Methods: the Functional FFRCT Score (FFS) combines CCTA and FFRCT parameters in an allocated point-based system. The feasibility of the FFS was assessed in cohort of 72 stable chest pain patients with matched CCTA and FFRCT datasets. Validation was performed using 2 cohorts: (a) 4468 patients from the ADVANCE Registry to define its association with revascularization and major adverse cardiovascular events (MACE); (b) 212 patients from the FORECAST trial to determine predictors of MACE.
Results: the median calculation time for the FFS was 10 (interquartile range 6–17) seconds, with strong intra-operator and inter-operator agreement (Cohen's Kappa 0.89 (±0.37, p < 0.001) and 0.83 (±0.04, p < 0.001, respectively). The FFS correlated strongly with both the CT-SYNTAX and the Functional CT-SYNTAX scores (rS = 0.808 for both, p < 0.001).
In the ADVANCE cohort the FFS had good discriminatory abilities for revascularization with an area under the curve of 0.82, 95 % confidence interval (CI) 0.81–0.84, p < 0.001. Patients in the highest FFS tertile had significantly higher rates of revascularization (61 % vs 5 %, p < 0.001) and MACE (1.9 % vs 0.5 %, p = 0.001) compared with the lowest FFS tertile.
In the FORECAST cohort the FFS was an independent predictor of MACE at 9-month follow-up (hazard ratio 1.04, 95 % CI 1.01–1.08, p < 0.01).
Conclusion: the FFS is a quick-to-calculate and reproducible score, associated with revascularization and MACE in two distinct populations of stable symptomatic patients.
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