Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial
| العنوان: | Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial |
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| المؤلفون: | Francesco Maisano, Marc Schönweiß, Ingrid Leal, Yosuke Miyazaki, Stefano De Martini, Marco Guglielmo, André Plass, Danny Schoors, Antonio L. Bartorelli, Thierry Folliguet, Daniele Andreini, Cristina Ferrari, Wietze Lindeboom, Saima Mushtaq, K Tanaka, G. Färber, Yuki Katagiri, Maurizio Roberto, Patrick W. Serruys, Rodrigo Modolo, Philipp A. Kaufmann, Yoshinobu Onuma, Jens Czapla, Xavier Orry, Laura Cavallotti, Paolo Olivares, Carlos Collet, Jeroen Sonck, Ioannis Diamantis, Pierre-Adrien Metzdorf, Giorgia Bonalumi |
| المساهمون: | Radiology, Medical Imaging, Clinical sciences, Cardiology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Heart failure & arrhythmias, Andreini, D, Modolo, R, Katagiri, Y, Mushtaq, S, Sonck, J, Collet, C, De Martini, S, Roberto, M, Tanaka, K, Miyazaki, Y, Czapla, J, Schoors, D, Plass, A, Maisano, F, Kaufmann, P, Orry, X, Metzdorf, Pa, Folliguet, T, Farber, G, Diamantis, I, Schonweiss, M, Bonalumi, G, Guglielmo, M, Ferrari, C, Olivares, P, Cavallotti, L, Leal, I, Lindeboom, W, Onuma, Y, Serruys, Pw, Bartorelli, Al, Investigators, Sir |
| المصدر: | Circulation-cardiovascular interventions, 12(12):e007607. Lippincott Williams & Wilkins Circulation. Cardiovascular interventions, 12(12). Lippincott Williams and Wilkins |
| بيانات النشر: | Lippincott Williams and Wilkins, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, Computed Tomography Angiography, medicine.medical_treatment, Clinical Decision-Making, Fractional flow reserve, 030204 cardiovascular system & hematology, Coronary Angiography, Severity of Illness Index, Decision Support Techniques, 030218 nuclear medicine & medical imaging, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, Heart team, Humans, Medicine, In patient, angiography, Coronary Artery Bypass, Patient Care Team, Syntax (programming languages), medicine.diagnostic_test, business.industry, Patient Selection, percutaneous coronary intervention, Coronary Stenosis, Coronary computed tomography angiography, Percutaneous coronary intervention, Prognosis, medicine.disease, Europe, Fractional Flow Reserve, Myocardial, Angiography, Cardiology, coronary computed tomography angiography, business, Cardiology and Cardiovascular Medicine, coronary artery disease, Decision-making |
| الوصف: | Background: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFR CT ) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFR CT on heart team’s treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease. Methods: The trial was an international, multicenter study randomizing 2 heart teams to make a treatment decision between percutaneous coronary interventions and coronary artery bypass grafting using either coronary computed tomography angiography or conventional angiography. The heart teams received the FFR CT and had to make a treatment decision and planning integrating the functional component of the stenoses. Each heart team calculated the anatomic SYNTAX score, the noninvasive functional SYNTAX score and subsequently integrated the clinical information to compute the SYNTAX score III providing a treatment recommendation, that is, coronary artery bypass grafting, percutaneous coronary intervention, or equipoise coronary artery bypass grafting-percutaneous coronary intervention. The primary objective was to determine the proportion of patients in whom FFR CT changed the treatment decision and planning. Results: Overall, 223 patients were included. Coronary computed tomography angiography assessment was feasible in 99% of the patients and FFR CT analysis in 88%. FFR CT was available for 1030 lesions (mean FFR CT value 0.64±13). A treatment recommendation of coronary artery bypass grafting was made in 24% of the patients with coronary computed tomography angiography with FFR CT . The addition of FFR CT changed the treatment decision in 7% of the patients and modified selection of vessels for revascularization in 12%. With conventional angiography as reference, FFR CT assessment resulted in reclassification of 14% of patients from intermediate and high to low SYNTAX score tertile. Conclusions: In patients with 3-vessel coronary artery disease, a noninvasive physiology assessment using FFR CT changed heart team’s treatment decision-making and procedural planning in one-fifth of the patients. Clinical Trial Registration: URL: https://www.clinicaltrials.govTest . Unique identifier: NCT02813473. |
| اللغة: | English |
| تدمد: | 1941-7640 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8261b2a7a8dae4c32a3f5450c93fd474Test https://doi.org/10.1161/circinterventions.118.007607Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....8261b2a7a8dae4c32a3f5450c93fd474 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19417640 |
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