Summary of Important Trial Results for Interventional Cardiology From ACC.19

Summary of Important Trial Results for Interventional Cardiology From ACC.19 : ADVANCE TRIAL

One-Year Impact on Medical Practice and Clinical Outcomes of FFRCT: The ADVANCE Registry

·This is an analysis of 5,083 patients prospectively enrolled in multicenter international registry from July 15, 2015, to October 20, 2017.

·Patients with documented coronary artery disease on computed tomography coronary angiography (CTCA) had computed tomography-derived fractional flow reserve (FFRCT) evaluated for lesions between 30% and 90% stenosis.

·The treating physicians were asked to submit a management plan based on the CTCA results initially and then an updated plan based on the results of the FFRCT. Impacts of FFRCT on treatment strategy, as well as patient outcomes, are reported in this analysis.

·The planned analysis included evaluation of the primary endpoint of major adverse cardiovascular events (MACE) at 1 year and downstream clinical management.

·The clinical endpoints included survival free from MACE inclusive of myocardial infarction (MI), all-cause mortality, or unplanned hospitalization for acute coronary syndrome (ACS) leading to revascularization.

·Furthermore, cardiovascular death in combination with MI was assessed at 1 year, as was the incidence of revascularization.

· Patients with stenosis >50% and FFRCT <0.8 were more likely to get revascularization. At 1 year, in patients with FFRCT >0.8, there was a trend toward lower MACE but statistically significant lower rates of cardiovascular death and MI.

· There was good incorporation of FFRCT results in the management plan, and most patients recommended for medical therapy remained on medical therapy at 1 year with no significant adverse events.

·These results, based on real-world observational data, support the potential application of CTCA enhanced with FFRCT for interventional revascularization decisions. This strategy should be considered for use in day-to-day practice.

By Tarek Helmy, MD, FACC
Center for Comprehensive Cardiovascular Care, Saint Louis University
St. Louis, MO, USA