Application and Performance of CT-Fractional Flow Reserve in Non-ST-Segment Elevation Myocardial Infarction

• Published in: The American journal of cardiology Vol. 247; pp. 6 - 12
• Main Authors: Warren, Josephine, Dawson, Luke, McCollom, Tori, Hudson, Lauren, Dagan, Misha, Zia, Adil, Kavnoudias, Helen, Lew, Philip, Shaw, James, Stub, Dion, Taylor, Andrew J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2025; Elsevier Limited
• Subjects: Adenosine; Aged; Algorithms; Angiography; Beta blockers; Blood pressure; Blood vessels; Cardiac CT; Cardiovascular disease; Computed tomography; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary artery disease; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary vessels; CT-fractional flow reserve; Drug dosages; Female; Fluid dynamics; Fractional Flow Reserve, Myocardial - physiology; Heart attacks; Heart diseases; Heart rate; Hemodynamics; Humans; Interrogation; Lesions; Machine learning; Male; Medical imaging; Middle Aged; Myocardial infarction; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - diagnostic imaging; Non-ST Elevated Myocardial Infarction - physiopathology; Non-ST-segment elevation myocardial infarction; Patients; Radiation; ROC Curve; Segments; Sensitivity analysis; Stenosis; Tomography; Vein & artery diseases; Work stations; CT-fractional flow reserve; Non-ST-segment elevation myocardial infarction; Cardiac CT
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2025.03.019

•The performance of CT-fractional flow reserve (CT-FFR) has not been previously evaluated in patients presenting with low-moderate risk NSTEMI.•In this study, CT-FFR provided additive diagnostic accuracy to coronary computed tomography angiography (CCTA) and demonstrated good correlation with invasive FFR.•CT-FFR may be a suitable gatekeeper to ICA in low-intermediate risk NSTEMI patients, especially in regional or remote settings.•Larger, multi-center studies are required to validate the use of CT-FFR in patients with NSTEMI. Only half of patients with non-ST-segment elevation myocardial infarction (NSTEMI) have obstructive coronary artery disease (CAD) on invasive coronary angiography (ICA). A non-invasive test that can safely rule out obstructive CAD therefore warrants investigation. Computed tomography fractional flow reserve (CT-FFR) enables hemodynamic interrogation of lesions identified on coronary computed tomography angiography (CCTA) but it has not been evaluated in NSTEMI. Inpatients with NSTEMI were recruited to undergo CCTA with CT-FFR prior to ICA. Blinded CT-FFR was performed using Siemens Frontiers cFFR, version 1.4. Invasive FFR was performed on all intermediate lesions with stenoses measuring >30% to <90%. The performance of CT-FFR and CTCA was compared to the gold-standard of ICA plus FFR. Forty patients (131 vessels) were included. The mean age was 61 ± 11 years and 75% were male. CT-FFR showed good correlation with invasive FFR (r = 0.78) and exhibited excellent diagnostic accuracy for obstructive CAD (defined as FFR<0.80 or angiographic stenosis >90%) on a per-vessel analysis, with a sensitivity of 87%, specificity 99%, positive predictive value (PPV) 97%, negative predictive value (NPV) 95% and area under the receiver operating curve (AUC) 0.93, which was superior to CCTA alone (sensitivity 82%, specificity 92%, PPV 82%, NPV 92%, AUC 0.87, p-value for AUC comparison = 0.04). On a per-patient analysis, CT-FFR had a diagnostic accuracy of 100%. In conclusion, CT-FFR provides additive diagnostic accuracy to CCTA in evaluating patients with NSTEMI and exhibits good correlation with invasive FFR.