Sequential strategy including FFRCT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study

Andrea Baggiano; Laura Fusini; Alberico Del Torto; Patrizia Vivona; Marco Guglielmo; Giuseppe Muscogiuri; Margherita Soldi; Chiara Martini; Enrico Fraschini; Mark G. Rabbat; Francesca Baessato; Gloria Cicala; Maria L. Danza; Annachiara Cavaliere; Antonella Loffreno; Vitanio Palmisano; Francesca Ricci; Giulia Rizzon; Elisabetta Tonet; Giacomo M. Viani; Saima Mushtaq; Edoardo Conte; Andrea D. Annoni; Alberto Formenti; Maria E. Mancini; Franco Fabbiocchi; Piero Montorsi; Daniela Trabattoni; Alexia Rossi; Fabio Fazzari; Nicola Gaibazzi; Daniele Andreini; Emilio M. Assanelli; Antonio L. Bartorelli; Mauro Pepi; Andrea I. Guaricci; Gianluca Pontone

doi:10.3390/jcm9072147

Sequential strategy including FFR_CT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study

Andrea Baggiano, Laura Fusini, Alberico Del Torto, Patrizia Vivona, Marco Guglielmo, Giuseppe Muscogiuri, Margherita Soldi, Chiara Martini, Enrico Fraschini, Mark G. Rabbat, Francesca Baessato, Gloria Cicala, Maria L. Danza, Annachiara Cavaliere, Antonella Loffreno, Vitanio Palmisano, Francesca Ricci, Giulia Rizzon, Elisabetta Tonet, Giacomo M. VianiSaima Mushtaq, Edoardo Conte, Andrea D. Annoni, Alberto Formenti, Maria E. Mancini, Franco Fabbiocchi, Piero Montorsi, Daniela Trabattoni, Alexia Rossi, Fabio Fazzari, Nicola Gaibazzi, Daniele Andreini, Emilio M. Assanelli, Antonio L. Bartorelli, Mauro Pepi, Andrea I. Guaricci, Gianluca Pontone^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.

Original language	English
Article number	2147
Pages (from-to)	1-17
Number of pages	17
Journal	Journal of Clinical medicine
Volume	9
Issue number	7
DOIs	https://doi.org/10.3390/jcm9072147
Publication status	Published - Jul 2020
Externally published	Yes

Keywords

Clinical management
Computed tomography
Coronary artery disease
Fractional flow reserve
Myocardial perfusion

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10.3390/jcm9072147

Cite this

Baggiano, A., Fusini, L., Torto, A. D., Vivona, P., Guglielmo, M., Muscogiuri, G., Soldi, M., Martini, C., Fraschini, E., Rabbat, M. G., Baessato, F., Cicala, G., Danza, M. L., Cavaliere, A., Loffreno, A., Palmisano, V., Ricci, F., Rizzon, G., Tonet, E., ... Pontone, G. (2020). Sequential strategy including FFR_CT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study. Journal of Clinical medicine, 9(7), 1-17. Article 2147. https://doi.org/10.3390/jcm9072147

@article{7de33db72bcf4802af1fd7b5feee0eb3,

title = "Sequential strategy including FFRCT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study",

abstract = "Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.",

keywords = "Clinical management, Computed tomography, Coronary artery disease, Fractional flow reserve, Myocardial perfusion",

author = "Andrea Baggiano and Laura Fusini and Torto, {Alberico Del} and Patrizia Vivona and Marco Guglielmo and Giuseppe Muscogiuri and Margherita Soldi and Chiara Martini and Enrico Fraschini and Rabbat, {Mark G.} and Francesca Baessato and Gloria Cicala and Danza, {Maria L.} and Annachiara Cavaliere and Antonella Loffreno and Vitanio Palmisano and Francesca Ricci and Giulia Rizzon and Elisabetta Tonet and Viani, {Giacomo M.} and Saima Mushtaq and Edoardo Conte and Annoni, {Andrea D.} and Alberto Formenti and Mancini, {Maria E.} and Franco Fabbiocchi and Piero Montorsi and Daniela Trabattoni and Alexia Rossi and Fabio Fazzari and Nicola Gaibazzi and Daniele Andreini and Assanelli, {Emilio M.} and Bartorelli, {Antonio L.} and Mauro Pepi and Guaricci, {Andrea I.} and Gianluca Pontone",

note = "Publisher Copyright: {\textcopyright} 2020 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2020",

month = jul,

doi = "10.3390/jcm9072147",

language = "English",

volume = "9",

pages = "1--17",

journal = "Journal of Clinical medicine",

issn = "2077-0383",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "7",

}

Baggiano, A, Fusini, L, Torto, AD, Vivona, P, Guglielmo, M, Muscogiuri, G, Soldi, M, Martini, C, Fraschini, E, Rabbat, MG, Baessato, F, Cicala, G, Danza, ML, Cavaliere, A, Loffreno, A, Palmisano, V, Ricci, F, Rizzon, G, Tonet, E, Viani, GM, Mushtaq, S, Conte, E, Annoni, AD, Formenti, A, Mancini, ME, Fabbiocchi, F, Montorsi, P, Trabattoni, D, Rossi, A, Fazzari, F, Gaibazzi, N, Andreini, D, Assanelli, EM, Bartorelli, AL, Pepi, M, Guaricci, AI & Pontone, G 2020, 'Sequential strategy including FFR_CT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study', Journal of Clinical medicine, vol. 9, no. 7, 2147, pp. 1-17. https://doi.org/10.3390/jcm9072147

TY - JOUR

T1 - Sequential strategy including FFRCT plus stress-CTP impacts on management of patients with stable chest pain

T2 - The stress-CTP ripcord study

AU - Baggiano, Andrea

AU - Fusini, Laura

AU - Torto, Alberico Del

AU - Vivona, Patrizia

AU - Guglielmo, Marco

AU - Muscogiuri, Giuseppe

AU - Soldi, Margherita

AU - Martini, Chiara

AU - Fraschini, Enrico

AU - Rabbat, Mark G.

AU - Baessato, Francesca

AU - Cicala, Gloria

AU - Danza, Maria L.

AU - Cavaliere, Annachiara

AU - Loffreno, Antonella

AU - Palmisano, Vitanio

AU - Ricci, Francesca

AU - Rizzon, Giulia

AU - Tonet, Elisabetta

AU - Viani, Giacomo M.

AU - Mushtaq, Saima

AU - Conte, Edoardo

AU - Annoni, Andrea D.

AU - Formenti, Alberto

AU - Mancini, Maria E.

AU - Fabbiocchi, Franco

AU - Montorsi, Piero

AU - Trabattoni, Daniela

AU - Rossi, Alexia

AU - Fazzari, Fabio

AU - Gaibazzi, Nicola

AU - Andreini, Daniele

AU - Assanelli, Emilio M.

AU - Bartorelli, Antonio L.

AU - Pepi, Mauro

AU - Guaricci, Andrea I.

AU - Pontone, Gianluca

PY - 2020/7

Y1 - 2020/7

N2 - Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.

AB - Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.

KW - Clinical management

KW - Computed tomography

KW - Coronary artery disease

KW - Fractional flow reserve

KW - Myocardial perfusion

UR - http://www.scopus.com/inward/record.url?scp=85098597864&partnerID=8YFLogxK

U2 - 10.3390/jcm9072147

DO - 10.3390/jcm9072147

M3 - Article

AN - SCOPUS:85098597864

SN - 2077-0383

VL - 9

SP - 1

EP - 17

JO - Journal of Clinical medicine

JF - Journal of Clinical medicine

IS - 7

M1 - 2147

ER -

Sequential strategy including FFR_CT plus stress-CTP impacts on management of patients with stable chest pain: The stress-CTP ripcord study

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Keywords

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