Background The prognostic value of coronary CT angiography (CTA)-derived quantitative flow ratio (CT-QFR) remains unknown. Purpose To determine the prognostic value of CT-QFR in predicting the long-term outcomes of patients with suspected coronary artery disease (CAD) in comparison with invasive coronary angiography (ICA)/SPECT and to determine the influence of prior percutaneous coronary intervention (PCI) on the prognostic value of CT-QFR. Materials and Methods In this secondary analysis of the prospective international CORE320 study, 379 participants who underwent coronary CTA and SPECT within 60 days before ICA between November 2009 and July 2011 were included for follow-up. The coronary CTA images were analyzed to determine CT-QFR. The primary outcome was major adverse cardiovascular events (MACEs) in the 5-year follow-up. Kaplan-Meier curves, multivariable Cox regression models adjusted for clinical variables, and areas under the receiver operating characteristic curves (AUCs) were used to assess and compare the predictive ability of CT-QFR and ICA/SPECT. Results CT-QFR computation and 5-year follow-up data were available for 310 participants (median age, 62 years), of whom 205 (66%) were male. CT-QFR (hazard ratio, 1.9 [95% CI: 1.0, 3.5]; P = .04) and prior myocardial infarction (hazard ratio, 2.5 [95% CI: 1.5, 4.0]; P < .001) were independent predictors of MACE occurrence in the 5-year follow-up. MACE-free survival rates were similar in participants with normal CT-QFR and ICA/SPECT (82% vs 80%; P = .45) and in participants with abnormal CT-QFR and ICA/SPECT findings (60% vs 57%; P = .40). In participants with prior PCI, CT-QFR had a lower AUC in predicting MACEs than in participants without prior PCI (0.44 vs 0.70; P < .001). Conclusion CT-QFR was an independent predictor of MACEs in the 5-year follow-up in participants with suspected CAD and showed similar 5-year prognostic value to ICA/SPECT; however, prior PCI affected CT-QFR ability to predict MACEs. Clinical trial registration no. NCT00934037 © RSNA, 2024 Supplemental material is available for this article.

中文翻译：

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冠状动脉 CT 血管造影衍生的定量流量比在疑似冠状动脉疾病中的预后价值。


背景 冠状动脉 CT 血管造影 （CTA） 衍生的定量流速比 （CT-QFR） 的预后价值仍然未知。目的 确定 CT-QFR 与有创冠状动脉造影 （ICA）/SPECT 相比预测疑似冠状动脉疾病 （CAD） 患者远期预后的预后价值，并确定既往经皮冠状动脉介入治疗 （PCI） 对 CT-QFR 预后价值的影响。材料和方法 在前瞻性国际CORE320研究的二次分析中，纳入了 2009 年 11 月至 2011 年 7 月期间在 ICA 前 60 天内接受冠状动脉 CTA 和 SPECT 的 379 名参与者进行随访。分析冠状动脉 CTA 图像以确定 CT-QFR。主要结局是 5 年随访中的主要不良心血管事件 （MACEs）。采用 Kaplan-Meier 曲线、针对临床变量调整的多变量 Cox 回归模型和受试者工作特征曲线下面积 （AUC） 评估和比较 CT-QFR 和 ICA/SPECT 的预测能力。结果 310 名参与者 （中位年龄，62 岁） 的 CT-QFR 计算和 5 年随访数据可用，其中 205 名 （66%） 为男性。CT-QFR（风险比，1.9 [95% CI： 1.0,3.5];P = .04） 和既往心肌梗死 （风险比，2.5 [95% CI： 1.5， 4.0];P < .001） 是 5 年随访中 MACE 发生的独立预测因子。CT-QFR 和 ICA/SPECT 正常的参与者的无 MACE 生存率相似 （82% vs 80%;P = .45）和 CT-QFR 和 ICA/SPECT 结果异常的参与者 （60% 对 57%;P = .40）。在既往有 PCI 的参与者中，CT-QFR 预测 MACE 的 AUC 低于既往无 PCI 的参与者（0.44 对 0.70;P < .001）. 结论 CT-QFR 是疑似 CAD 参与者 5 年随访中 MACEs 的独立预测因子，其 5 年预后价值与 ICA/SPECT 相似;然而，既往 PCI 影响了 CT-QFR 预测 MACE 的能力。临床试验注册号© NCT00934037 RSNA， 2024 本文提供补充材料。