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Clinical Value of Computational Angiography-derived Fractional Flow Reserve in Stable Coronary Artery Disease

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Abstract

The utilization of FFR remains low. Our study evaluated the per-vessel prognostic value of computational pressure-flow dynamics-derived FFR (caFFR) among patients with stable coronary artery disease. A total of 3329 vessels from 1308 patients were included and analysed. They were stratified into ischaemic (caFFR ≤ 0.8) and non-ischaemic (caFFR > 0.8) cohorts, and the associations between PCI and outcomes were evaluated. The third cohort comprised all included vessels, and the associations between treatment adherent-to-caFFR (PCI in vessels with caFFR ≤ 0.8 and no PCI in vessels with caFFR > 0.8) and outcomes were evaluated. The primary outcome was VOCE, defined as a composite of vessel-related cardiovascular mortality, non-fatal myocardial infarction, and repeat revascularization. PCI was associated with a lower 3-year risk of VOCE in the ischaemic cohort (HR, 0.44; 95% CI, 0.26–0.74; P = 0.002) but not in the non-ischaemic cohort. The risk of VOCE was lower in the adherent-to-caFFR group (n = 2649) (HR, 0.69; 95% CI, 0.48–0.98; P = 0.039).

Graphical Abstract

A novel index that uses coronary angiography images to estimate FFR may have substantial clinical value in guiding management among patients with stable coronary artery disease.

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Data Availability

Data are available on reasonable request.

Abbreviations

caFFR:

Computational pressure-flow dynamics-derived fractional flow reserve

CFD:

Computational fluid dynamics

CI:

Confidence interval

CPFD:

Computational pressure-flow dynamics

FFR:

Fractional flow reserve

GEE:

Generalized estimating equations

HR:

Hazard ratio

VOCE:

Vessel-oriented composite endpoint

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Acknowledgements

We thank the medical staff of the Division of Cardiology, Queen Mary Hospital for their support during this study.

Funding

This work was supported by HKU-SZH Fund for Shenzhen Key Medical Discipline, Grant Number: SZXK2020081, and Sanming Project of Cardiology, the university of Hong Kong Shenzhen hospital, Sanming Grant from the Ministry of Health, Shenzhen, China, Grant Number: SZSM201911020.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China

    Calvin Ka-Lam Leung, Lok-Yee Lam, Kwan-Yu Li, Gaozhen Cao, Min Wu, Run Wang, Mei-Zhen Wu, Qing-Wen Ren, Hung-Fat Tse & Kai-Hang Yiu

  2. Division of Cardiology, Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Room 1929B/K1931, 19/F, Block K, Hong Kong, China

    Calvin Ka-Lam Leung, Lok-Yee Lam, Kwan-Yu Li, Mei-Zhen Wu, Qing-Wen Ren, Si-Yeung Yu, Yi-Kei Tse, Hang-Long Li, Shuk-Yin Yu, Hung-Fat Tse & Kai-Hang Yiu

  3. PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China

    Yundi Feng

  4. National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China

    Bo Xu

  5. National Clinical Research Center for Cardiovascular Diseases, Beijing, China

    Bo Xu

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  1. Calvin Ka-Lam Leung
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Contributions

Study concept and design: CKLL, LYL, KYL, KHY. Data analysis and interpretation: CKLL, LYL, KYL, YF, SYY. Manuscript drafting: CKLL, LYL, KYL, KHY. Critical revision of the manuscript and intellectual input: CKLL, GC, MW, RW, MZW, QWR, SYY, YKT, HLL, HFT, BX. Guarantor: KHY.

Corresponding author

Correspondence to Kai-Hang Yiu.

Ethics declarations

Human Subjects

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. This study was approved by the ethics committee of the West Cluster Hospital Authority of Hong Kong. The need for informed consent was waived.

Animal Studies

No animal studies were carried out by the authors for this article.

Conflict of Interest

KHY receives research support from Novartis; consultancy fees from service on the Advisory Board/Steering Committee for Abbott Diagnostics, Bayer, Boehringer Ingelheim, Boston Scientific, Medtronic, and Novartis. All other authors report no conflict of interest.

Additional information

Associate Editor Yihua Bei oversaw the review of this article

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Clinical Relevance

This study, to the best of our knowledge, is the first to demonstrate a favourable clinical performance in patients with stable CAD by adhering to values derived by a non-wire-based per-vessel angiography-derived functional assessment. These findings support the use of caFFR and its potential for widespread application in clinical practice.

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Leung, C.KL., Lam, LY., Li, KY. et al. Clinical Value of Computational Angiography-derived Fractional Flow Reserve in Stable Coronary Artery Disease. J. of Cardiovasc. Trans. Res. 16, 1166–1176 (2023). https://doi.org/10.1007/s12265-023-10381-x

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