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- Title
The prognostic value of CT-derived fractional flow reserve in coronary artery bypass graft: a retrospective multicenter study.
- Authors
Zu, Zi Yue; Xu, Peng Peng; Chen, Qian; Chen, Yan Chun; Qi, Jian Chen; Tang, Chun Xiang; Zhou, Chang Sheng; Xu, Cheng; Sun, Xin Jie; Lu, Meng Jie; Lu, Guang Ming; Wang, Yi Ning; Xu, Yi; Zhang, Long Jiang
- Abstract
Objectives: To investigate the predictive value of CT-derived fractional flow reserve (FFRCT) in anastomosis occlusion after coronary artery bypass graft (CABG) surgery. Methods: Patients undergoing CABG with both pre- and post-operative coronary computed tomographic angiography (CCTA) were retrospectively included. Preoperative CCTA studies were used to evaluate anatomical and FFRCT information of target vessels. A diameter stenosis (DS) ≥ 70% or left main > 50% was considered to be anatomically severe, while FFRCT value ≤ 0.80 be functionally significant. The primary endpoint was anastomosis occlusion evaluated on post-operative CCTA during follow-up. Predictors of anastomosis occlusion were assessed by the multivariate binary logistic regression with generalized estimating equations. Results: A total of 270 anastomoses were identified in 88 enrolled patients. Forty-one anastomoses from 30 patients exhibited occlusion during a follow-up of 15.3 months after CABG. The occluded group had significantly increased prevalence of non-severe DS (58.5% vs. 40.2%; p = 0.023) and non-significant FFRCT (48.8% vs. 10.0%; p < 0.001). Multivariable analysis indicated FFRCT ≤ 0.80 (odds ratio [OR]: 0.10, 95% CI: 0.03–0.33; p < 0.001) and older age (OR: 0.92, 95% CI: 0.87–0.97; p = 0.001) were predictors for bypass patency during follow-up, while myocardial infarction history and anastomosis to a local lesion or bifurcation (all p value < 0.05) were predictors of occlusion. Adding FFRCT into the model based on the clinical and anatomical predictors had an improved AUC of 0.848 (p = 0.005). Conclusions: FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. Preoperative judgment of the hemodynamic significance may improve the CABG surgery strategy and reduce graft failure. Key Points: • FFRCT≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. • The addition of FFRCTinto the integrated model including clinical (age and history of myocardial infarction) and anatomical CCTA indicators (local lesion and bifurcation) significantly improved the model performance with an AUC of 0.848 (p = 0.005). • Preoperative judgment of the hemodynamic significance may help improve the decision-making and surgery planning in patients indicated for CABG and significantly reduce graft failure, without an extra radiation exposure and risk of invasive procedure.
- Subjects
CORONARY artery bypass; PROGNOSIS; CORONARY occlusion; GENERALIZED estimating equations
- Publication
European Radiology, 2023, Vol 33, Issue 5, p3029
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-022-09353-7