2018 JACC CI (PERFECTION study)
OBJECTIVES This study sought to compare the diagnostic accuracy of coronary computed tomography angiography (cCTA) with that of cCTAþfractional flow reserve derived from cCTA datasets (FFRCT) and that of cCTAþstatic stresscomputed tomography perfusion (stress-CTP) in detecting functionally significant coronary artery lesions using invasive coronary angiography (ICA) plus invasive FFR as the reference standard. BACKGROUND FFRCT and static stress-CTP are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using cCTA. METHODS A total of 147 consecutive symptomatic patients scheduled for clinically indicated ICAþinvasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. RESULTS Vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values, and accuracy rates of cCTA were 99%, 76%, 100%, 61%, 82%, and 95%, 54%, 94%, 63%, 73%, respectively. cCTAþFFRCT showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 88%, 94%, 95%,84%, 92%, and 90%, 85%, 92%, 83%, 87%, respectively. Finally, cCTAþstress-CTP showed vessel-based and patient-based sensitivity, specificity, and negative predictive values, and positive predictive values and accuracy rates of 92%, 95%, 97%, 87%,94%and 98%, 87%, 99%, 86%, 92%, respectively. Both FFRCT and stress-CTP significantly improved specificity and positive predictive values compared to those of cCTA alone. The area under the curve to detect flow-limiting stenoses of cCTA, cCTAþFFRCT, and cCTAþCTP were 0.89, 0.93, 0.92, and 0.90, 0.94, and 0.93 in a vessel-based and patient-based model, respectively, with significant additional values for both cCTAþFFRCT and cCTAþCTP versus cCTA alone (p < 0.001) but no differences between cCTAþFFRCT versus cCTAþCTP. CONCLUSIONS FFRCT and stress-CTP in addition to cCTA are valid and comparable tools to evaluate the functional relevance of CAD.