Evidence map›Paper›PMID 32166492›Full record

Observational studyEuropean radiology2020

Impact of machine-learning CT-derived fractional flow reserve for the diagnosis and management of coronary artery disease in the randomized CRESCENT trials.

Fay M A Nous, Ricardo P J Budde, Marisa M Lubbers, Yuzo Yamasaki, Isabella Kardys, Tobias A Bruning, Jurgen M Akkerhuis, Marcel J M Kofflard, Bas Kietselaer, Tjebbe W Galema and 1 more

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European radiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
1.8field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.

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  18. Prevalence of pathological FFREuropean radiology · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 2 countries.

Fay M A NousDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Ricardo P J BuddeDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Marisa M LubbersDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Yuzo YamasakiDepartment of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi Ward, Fukuoka, 812-8582, Japan.
Isabella KardysDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Tobias A BruningDepartment of Cardiology, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
Jurgen M AkkerhuisDepartment of Cardiology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
Marcel J M KofflardDepartment of Cardiology, Albert Schweitzer Ziekenhuis, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands.
Bas KietselaerDepartment of Cardiology, Zuyderland Medical Center, H. Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
Tjebbe W GalemaDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Koen NiemanDepartment of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. knieman@stanford.edu.
Erasmus MC · NLAlbert Schweitzer Ziekenhuis · NLKyushu University · JPMaasstad Ziekenhuis · NLSint Franciscus Gasthuis · NLZuyderland Medisch Centrum · NL

Funding

Comprehensive CT Guided Coronary Artery Bypass Graft SurgeryR01HL141712 · NHLBI · STANFORD UNIVERSITY · PI NIEMAN, KOEN · 2019 to 2023
$3.5M
Hartstichting NHS 2013T071Hartstichting NHS 2014T061NHLBI NIH HHS R01 HL141712
6 · The paper itself

Abstract

objectiveTo determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA.

methodsThis observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. We retrospectively assessed the effect of adding CT-FFR to the CT protocol in patients with a stenosis ≥ 50% on CCTA in terms of diagnostic effectiveness, i.e., the number of additional tests required to determine the final diagnosis, reclassification of the initial management strategy, and invasive coronary angiography (ICA) efficiency, i.e., ICA rate without ≥ 50% CAD.

resultsFifty-three patients out of the 372 patients (14%) had at least one ≥ 50% stenosis on CCTA of whom 42/53 patients (79%) had no exclusion criteria for CT-FFR. CT-FFR showed a hemodynamically significant stenosis (≤ 0.80) in 27/53 patients (51%). The availability of CT-FFR would have reduced the number of patients requiring additional testing by 57%-points compared with CCTA alone (37/53 vs. 7/53, p < 0.001). The initial management strategy would have changed for 30 patients (57%, p < 0.001). Reserving ICA for patients with a CT-FFR ≤ 0.80 would have reduced the number of ICA following CCTA by 13%-points (p = 0.016).

conclusionImplementation of on-site CT-FFR may change management and improve diagnostic efficiency and effectiveness in patients with obstructive CAD on CCTA. KEY POINTS: • The availability of on-site CT-FFR in the diagnostic evaluation of patients with obstructive CAD on CCTA would have significantly reduced the number of patients requiring additional testing compared with CCTA alone. • The implementation of on-site CT-FFR would have changed the initial management strategy significantly in the patients with obstructive CAD on CCTA. • Restricting ICA to patients with a positive CT-FFR would have significantly reduced the ICA rate in patients with obstructive CAD on CCTA.

Indexed as

Fractional Flow Reserve, MyocardialMachine LearningAgedCardiac CatheterizationCohort StudiesComputed Tomography AngiographyCoronary AngiographyCoronary Artery DiseaseCoronary StenosisDisease ManagementFemaleHemodynamicsHumansMaleMiddle AgedPercutaneous Coronary InterventionComputed tomography angiographyCoronary artery diseaseMyocardial fractional flow reserveMyocardial ischemiaMyocardial perfusion imaging

Identifiers

PMID32166492
PMCPMC8862271
OpenAlexW3011819463

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.