A meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of coronary artery calcium score
European Radiology(2024)
摘要
Objectives The impact of coronary calcification on the diagnostic accuracy of computed tomography-derived fractional flow reserve (CT-FFR) and coronary computed tomography angiography (CCTA) remains a crucial consideration. This meta-analysis aims to compare the diagnostic performance of CT-FFR and CCTA at different levels of coronary artery calcium score (CACS). Methods and results We searched PubMed, Embase, and the Cochrane Library for relevant articles on CCTA, CT-FFR, and invasive fractional flow reserve (FFR). Ten studies were included to evaluate the diagnostic performance of CT-FFR and CCTA at the per-patient and per-vessel levels in four CACS groups. Invasive FFR was used as the reference standard. Except for the CACS ≥ 400 group, the AUC of CT-FFR was higher than those of CCTA in other subgroups of CACS (in CACS < 100 (per-patient, 0.9 (95% CI 0.87–0.92) vs. 0.32 (95% CI 0.28–0.36); per-vessel, 0.92 (95% CI 0.89–0.94) vs. 0.66 (95% CI 0.62–0.7); both p < 0.001), CACS ≥ 100 (per-patient, 0.86 (95% CI 0.82–0.88) vs. 0.44 (95% CI 0.4–0.48); per-vessel, 0.88 (95% CI 0.85–0.9) vs. 0.51 (95% CI 0.46–0.55); both p < 0.001), and CACS < 400 (per-patient, 0.9 (95% CI 0.87–0.93) vs. 0.74 (95% CI 0.7–0.78), p < 0.001; per-vessel, 0.8 (95% CI 0.76–0.83) vs. 0.74 (95% CI 0.7–0.78); p = 0.02)). Conclusions CT-FFR demonstrates superior diagnostic performance in low CACS groups (CACS < 400) than CCTA in detecting hemodynamic stenoses in patients with coronary artery disease (CAD). Clinical relevance statement Computed tomography-derived fractional flow reserve might be utilized to determine the necessity of invasive coronary angiography in coronary artery disease patients with coronary artery calcium score < 400. Key Points • There is a lack of meta-analysis comparing the diagnostic performance of computed tomography-derived fractional flow reserve and coronary computed tomography angiography at different levels of calcification. • Computed tomography-derived fractional flow reserve only has a better diagnostic performance than coronary computed tomography angiography with low amounts of coronary calcium. • For the low coronary artery calcium score group, computed tomography-derived fractional flow reserve might be a good non-invasive method to detect hemodynamic stenoses in coronary artery disease patients.
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关键词
Coronary artery disease,Hemodynamics,Vascular calcification,Computed tomography angiography
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