Assessment of fractional flow reserve in patients with recent Non–ST-Segment–Elevation Myocardial Infarction

Layland, J. et al. (2015) Assessment of fractional flow reserve in patients with recent Non–ST-Segment–Elevation Myocardial Infarction. Circulation: Cardiovascular Interventions, 8(8), e002207. (doi:10.1161/circinterventions.114.002207) (PMID:26253733)

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Abstract

Background—The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-ST-Elevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non–ST-segment–elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3.0-T stress CMR perfusion. Methods and Results—One hundred six patients with non–ST-segment–elevation myocardial infarction who had been referred for early invasive management were included from 2 centers. FFR was measured in all major patent epicardial coronary arteries with a visual stenosis estimated at ≥30%, and if percutaneous coronary intervention was performed, an FFR assessment was repeated. Myocardial perfusion was assessed with stress perfusion CMR at 3 T. The mean age was 56.7±9.8 years; 82.6% were men. Mean time from FFR evaluation to CMR was 6.1±3.1 days. The mean±SD left ventricular ejection fraction was 58.2±9.1%. Mean infarct size was 5.4±7.1%, and mean troponin concentration was 5.2±9.2 μg/L. There were 34 fixed and 160 inducible perfusion defects. There was a negative correlation between the number of segments with a perfusion abnormality and FFR (r=−0.77; P<0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value for an FFR of ≤0.8 were 91.4%, 92.2%, 76%, and 97%, respectively. Diagnostic accuracy was 92%. The positive and negative predictive values of FFR for flow-limiting coronary artery disease (FFR≤0.8) in patients with non–ST-segment–elevation myocardial infarction (n=21) who underwent perfusion CMR before invasive angiography were 92% and 93%, respectively. Receiver operating characteristic analysis indicated that the optimal cutoff value of FFR for demonstrating reversible ischemia on CMR was ≤0.805 (area under the receiver operating characteristic curve, 0.94 [0.9–0.99]; P<0.0001). Conclusions—FFR in patients with recent non–ST-segment–elevation myocardial infarction showed high concordance with myocardial perfusion in matched territories as revealed by 3.0-T stress perfusion CMR.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Lee, Matthew and Carrick, Dr David and Petrie, Professor Mark and Rauhalammi, Mr Samuli and Eteiba, Dr Hany and Oldroyd, Dr Keith and Layland, Dr Jamie and McClure, Dr John and Radjenovic, Dr Aleksandra
Authors: Layland, J., Rauhalammi, S., Watkins, S., Ahmed, N., McClure, J., Lee, M. M.Y., Carrick, D., O’Donnell, A., Sood, A., Petrie, M. C., Teng Yue May, V., Eteiba, H., Lindsay, M., McEntegart, M., Oldroyd, K. G., Radjenovic, A., and Berry, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Circulation: Cardiovascular Interventions
Publisher:American Heart Association
ISSN:1941-7640
ISSN (Online):1941-7632

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
575371Fractional Flow Reserve versus Angiographically Guided Management to Optimise Outcomes in Unstable Coronary Syndromes: a Developmental Clinical StudyColin BerryBritish Heart Foundation (BHF)PG/11/55/28999RI CARDIOVASCULAR & MEDICAL SCIENCES