Incidence and Predictors of Lesion-specific Ischemia by FFR: Learnings from the International ADVANCE Registry

Background: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.

Methods: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFR were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFR findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR.

Results: FFR data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFR value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFR. In addition, >70% stenosis was significantly associated with low FFR (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001).

Conclusions: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.