Ability of FFR-CT to detect the absence of hemodynamically significant lesions in patients with high-risk NSTE-ACS admitted in the emergency department with chest pain, study design and rationale.

FFR - CT 检测在急诊科收治的胸痛高危 NSTE - ACS 患者中没有血流动力学显著病变的能力 ，研究设计和基本原理。

• 发表时间: Apr 2020
• 来源期刊: Int J Cardiol Heart Vasc
• DOI: 10.1016/j.ijcha.2020.100496
• PMID: 32181323
• 文章类型: Journal Article
• 作者列表: Meier D,Skalidis I,De Bruyne B,Qanadli SD,Rotzinger D,Eeckhout E,Collet C,Muller O,Fournier S

关键词: ACS, Acute coronary syndrome; AE, Adverse Event; Acute coronary syndrome; CMRI, Cardiac Magnetic resonance imaging; CT, Computed tomography; Coronary computed tomography; ECG, Electrocardiogram; ED, Emergency department; FFR, Fractional Flow Reserve; FFR-CT; FFR-CT, FFR derived from coronary CT; Fractional Flow Reserve; Hs-Tn, High-sensitive troponins; MACE, Major adverse cardiac events; MI, Myocardial infraction; NSTE-ACS, Acute coronary syndromes without ST-segment elevation; NSTEMI, Non-ST-elevation myocardial infarction; PCI, Percutaneous Coronary Intervention; STEMI, ST-elevation myocardial infarction; URL, Upper Range Limit

Abstract

BACKGROUND: In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS).
OBJECTIVE: The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS.
METHODS: We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared.
UNASSIGNED: In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs.

摘要

背景：在高敏肌钙蛋白（hs-Tn）时代，高达50%的hs-Tn轻度增加的患者最终会有正常的侵入性冠状动脉造影。冠状动脉计算机断层血管造影术（FFR-CT）得出的血流储备分数（FFR）从未被用作诊断无ST段抬高的高风险急性冠状动脉综合征（NSTE-ACS）患者冠状动脉疾病的非侵入性工具。
目的：本研究旨在确定冠状动脉CT血管造影和FFR-CT在高危NSTE-ACS中的作用。
方法：我们将进行一项前瞻性试验，纳入250例高危NSTE-ACS患者，他们将迅速接受冠状动脉CT血管造影，然后进行冠状动脉血管造影并测量FFR。冠状动脉CT检查结果,将比较FFR-CT和冠状动脉造影(±FFR)。
■总而言之，对可以避免冠状动脉造影的高危NSTE-ACS患者进行非侵入性识别将降低手术相关风险和医疗费用.