The DOI matches its Crossref record; 25 of the 25 references it cites were found in a registry or an index.
Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography
Open accessAbstract
CONTEXT: Coronary computed tomographic (CT) angiography is a noninvasive anatomic test for diagnosis of coronary stenosis that does not determine whether a stenosis causes ischemia. In contrast, fractional flow reserve (FFR) is a physiologic measure of coronary stenosis expressing the amount of coronary flow still attainable despite the presence of a stenosis, but it requires an invasive procedure. Noninvasive FFR computed from CT (FFR(CT)) is a novel method for determining the physiologic significance of coronary artery disease (CAD), but its ability to identify ischemia has not been adequately examined to date. OBJECTIVE: To assess the diagnostic performance of FFR(CT) plus CT for diagnosis of hemodynamically significant coronary stenosis. DESIGN, SETTING, AND PATIENTS: Multicenter diagnostic performance study involving 252 stable patients with suspected or known CAD from 17 centers in 5 countries who underwent CT, invasive coronary angiography (ICA), FFR, and FFR(CT) between October 2010 and October 2011. Computed tomography, ICA, FFR, and FFR(CT) were interpreted in blinded fashion by independent core laboratories. Accuracy of FFR(CT) plus CT for diagnosis of ischemia was compared with an invasive FFR reference standard. Ischemia was defined by an FFR or FFR(CT) of 0.80 or less, while anatomically obstructive CAD was defined by a stenosis of 50% or larger on CT and ICA. MAIN OUTCOME MEASURES: The primary study outcome assessed whether FFR(CT) plus CT could improve the per-patient diagnostic accuracy such that the lower boundary of the 1-sided 95% confidence interval of this estimate exceeded 70%. RESULTS: Among study participants, 137 (54.4%) had an abnormal FFR determined by ICA. On a per-patient basis, diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of FFR(CT) plus CT were 73% (95% CI, 67%-78%), 90% (95% CI, 84%-95%), 54% (95% CI, 46%-83%), 67% (95% CI, 60%-74%), and 84% (95% CI, 74%-90%), respectively. Compared with obstructive CAD diagnosed by CT alone (area under the receiver operating characteristic curve [AUC], 0.68; 95% CI, 0.62-0.74), FFR(CT) was associated with improved discrimination (AUC, 0.81; 95% CI, 0.75-0.86; P < .001). CONCLUSION: Although the study did not achieve its prespecified primary outcome goal for the level of per-patient diagnostic accuracy, use of noninvasive FFR(CT) plus CT among stable patients with suspected or known CAD was associated with improved diagnostic accuracy and discrimination vs CT alone for the diagnosis of hemodynamically significant CAD when FFR determined at the time of ICA was the reference standard.
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Cites
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“These concerns stem from recent randomized trials that have identified no survival benefit for patients who undergo angiographically based coronary revascularization.(6,7) As an adjunct to ICA, fractional flow reserve (FFR) has served as a useful tool to determine the likelihood that a coronary”
BackgroundSelf-citationFractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention
Tonino, P. A. L., De Bruyne, B., Pijls, N. H. J., Siebert, U., Ikeno, F., van `t Veer, M., Klauss, V., Manoharan, G., Engstrøm, T., Oldroyd, K. G., et al. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0807611 · Cited by 4,260
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Self-citationACC/AHA/ASNC Guidelines for the Clinical Use of Cardiac Radionuclide Imaging—Executive Summary
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Cited by
2018 ESC/EACTS guidelines on myocardial revascularization
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2013 ESC guidelines on the management of stable coronary artery disease
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STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration
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Metadata
- Authors
- Min, J. K., Leipsic, J., Pencina, M. J., Berman, D. S., Koo, B.-K., van Mieghem, C., Erglis, A., Lin, F. Y., Dunning, A. M., Apruzzese, P., Budoff, M. J., Cole, J. H., Jaffer, F. A., Leon, M. B., Malpeso, J., Mancini, G. B. J., Park, S.-J., Schwartz, R. S., Shaw, L. J., & Mauri, L.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-09-26
- Volume
- 308
- Issue
- 12
- Pages
- 1237
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2095680098
- Cited by
- 1,162
- References
- 25
- FWCI
- 69.65
- Type
- journal article
- Language
- en
- Open access
- green
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- Min, J. K., Leipsic, J., Pencina, M. J., Berman, D. S., Koo, B.-K., van Mieghem, C., Erglis, A., Lin, F. Y., Dunning, A. M., Apruzzese, P., Budoff, M. J., Cole, J. H., Jaffer, F. A., Leon, M. B., Malpeso, J., Mancini, G. B. J., Park, S.-J., Schwartz, R. S., Shaw, L. J., & Mauri, L. (2012). Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography. JAMA. https://doi.org/10.1001/2012.jama.11274
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