Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale

David Meier; Ioannis Skalidis; Bernard De Bruyne; Salah Dine Qanadli; David Rotzinger; Eric Eeckhout; Carlos Collet; Olivier Muller; Stephane Fournier

doi:10.1016/j.ijcha.2020.100496

Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale

Int J Cardiol Heart Vasc. 2020 Mar 5:27:100496. doi: 10.1016/j.ijcha.2020.100496. eCollection 2020 Apr.

Authors

Affiliations

¹ Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
² Cardiovascular Center Aalst, Aalst, Belgium.
³ Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland.
⁴ Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy.

Abstract

Background: In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS).

Aims: The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS.

Methodology: We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared.

Potential significance: In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.

Keywords: ACS, Acute coronary syndrome; AE, Adverse Event; Acute coronary syndrome; CMRI, Cardiac Magnetic resonance imaging; CT, Computed tomography; Coronary computed tomography; ECG, Electrocardiogram; ED, Emergency department; FFR, Fractional Flow Reserve; FFR-CT; FFR-CT, FFR derived from coronary CT; Fractional Flow Reserve; Hs-Tn, High-sensitive troponins; MACE, Major adverse cardiac events; MI, Myocardial infraction; NSTE-ACS, Acute coronary syndromes without ST-segment elevation; NSTEMI, Non-ST-elevation myocardial infarction; PCI, Percutaneous Coronary Intervention; STEMI, ST-elevation myocardial infarction; URL, Upper Range Limit.