Table 4.
Summery of the studies and the trials for computed tomography-fractional flow reserve
| Study/trial | Objectives | Study type | Results |
|---|---|---|---|
| DISCOVER-FLOW study [98] | Diagnostic performance (CT-FFR vs CTA) |
Prospective Multicenter |
A higher AUC of CT-FFR than CTA (per-patient and per-vessel) Good correlation of CT-FFR values with FFR values |
| DeFACTO study [99] | Diagnostic performance (CT-FFR vs CTA) |
Prospective Multicenter |
A higher AUC of CT-FFR than CTA (per-patient) |
| NXT trial [100] | Diagnostic performance (CT-FFR vs CTA) |
Prospective Multicenter |
A higher accuracy of CT-FFR than CTA (per-patient and per-vessel) A higher AUC of CT-FFR than CTA (per-patient and per-vessel) |
| PLATFORM trial [123, 124] | The clinical, economic, and quality-of-life outcomes of using CT-FFR instead of usual care |
Prospective Multicenter |
61% cancellation of ICA with no adverse events at the 90-day follow-up Infrequency of adverse events at the 12-month follow-up 33% lower costs with CT-FFR in the ICA planned patients |
| FFRCT RIPCORD study [125] | The effect of adding CT-FFR to CTA alone for assessment of severity and patient management in patients with stable chest pain |
Retrospective Multicenter (dataset from NXT study) |
30% reduction in PCI, an 18% change in the target vessel Reassignment from OMT to PCI in 12% of cases |
| SYNTAX III Revolution trial [126, 127] | The feasibility of decision-making and treatment planning based only on non-invasive imaging in patients with LMT or 3VD |
Prospective Multicenter |
Decision-making with CTA and CT-FFR was feasible 7% change in the treatment recommendation, 12% change in the target vessels (addition of CT-FFR to CTA alone) |
| ADVANCE FFRCT study [129] | Real-world clinical utility on decision-making of CT-FFR in patients with symptoms concerning for CAD |
Prospective Multicenter |
Low event rate, fewer MACE, and less revascularization in patients with negative CT-FFR at the 12-month follow-up |
| PERFECTION study [91] | Diagnostic performance (CTA + CT-FFR vs CTA + static CTP) |
Prospective Multicenter |
Better diagnostic performance of both CTA + CT-FFR and CTA + static CTP than CTA alone (Specificity, PPV, and AUC) No differences between CTA + CT-FFR vs CTA + static CTP |
AUC area under the curve, CAD coronary artery disease, CTA computed tomography angiography, CT-FFR computed tomography–derived fractional flow reserve, CTP computed tomography perfusion, ICA invasive coronary angiography, LMT left main trunk, MACE major adverse cardiac events, OMT optimal medical therapy, PPV positive predictive value, PCI percutaneous coronary intervention, 3VD triple-vessel disease