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New Non-Invasive Test Identifies Coronary Artery Blockages

FFRCT compares the maximum achievable blood flow in a diseased coronary artery with the theoretical maximum flow in a normal one, eliminating the need to diagnose the problem via cardiac catheterization….

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In 2014, the US Food and Drug Administration approved a software program called FFRCT that can noninvasively identify coronary artery blockages. The FFRCT calculates fractional flow reserve based on computed tomography scans of the patient’s heart. FFRCT compares the maximum achievable blood flow in a diseased coronary artery with the theoretical maximum flow in a normal one, eliminating the need to diagnose the problem via cardiac catheterization.

In a test run of the FFRCT, imaging of both coronary anatomy and ischemic potential led to reallocation of treatment assignment based on CT angiography alone in 36% of cases. This means there were significant differences in the treatment decisions based solely on visually apparent lesion severity versus visual severity plus estimated lesion functional impact.

The study, called FFRCT RIPCORD was based on three interventionists’ reading of CTA scans from 200 consecutive stable patients with chest pain of unknown origin. A management plan was decided upon based on the anatomic appearance of lesions. They allocated each patient to receive OMT alone, PCI plus OMT, or CABG plus OMT or designated them as "more information required." Then the FFR data component of the scans was added to imaging in each case, and the process was repeated based on FFRCT. Lastly, the clinicians reallocated a management plan consisting of OMT alone or with PCI or CABG.

The potential effect of the FFRCT on patients in the study was significant with 12% of patients who would have been assigned to just optimal medical therapy based on a standard CTA were sent to revascularization instead based on FFRCT. Moreover, 30% of patients who would have undergone PCI based on CTA alone were reassigned to optical medical therapy. Even 18% of those allocated to PCI based on CTA had their target vessel switched to another based on FFRCT.

Practice Pearls:

  • FFRCT could drastically change the process of identifying and eliminating coronary artery blockages.
  • More substantial clinical trials must confirm the current finding of the effectiveness of the FFRCT.
  • Unfortunately, many patients may be undergoing invasive procedures unnecessarily, increasing their risk of mortality.

Charles Taylor, Journal of the American College of Cardiology, Volume 61, Issue 22, 4 June 2013, Pages 2233–2241.