Coronary CT-based FFR in patients with acute myocardial infarction might predict follow-up invasive FFR: The XPECT-MI study

Background: We aimed to evaluate whether invasive fractional flow reserve (FFRi) of non-infarction related (non-IRA) lesions changes over time in ST-elevation myocardial infarction (STEMI) patients. Moreover, we assessed the diagnostic performance of coronary CT angiography-derived FFR(FFRCT) following the index event in predicting follow-up FFRi. Methods: We prospectively enrolled 38 STEMI patients (mean age 61.6 +/- 9 years, 23.1% female) who underwent non-IRA baseline and follow-up FFRi measurements and a baseline FFRCT (within <= 10 days after STEMI). Follow-up FFRi was performed at 45-60 days (FFRi and FFRCT value of <= 0.8 was considered positive). Results: FFRi values showed significant difference between baseline and follow-up (median and interquartile range (IQR) 0.85 [0.78-0.92] vs. 0.81 [0.73-0.90] p = 0.04, respectively). Median FFRCT was 0.81 [0.68-0.93]. In total, 20 lesions were positive on FFRCT. A stronger correlation and smaller bias were found between FFRCT and follow-up FFRi (rho = 0.86,p < 0.001,bias:0.01) as compared with baseline FFRi (rho = 0.68, p < 0.001,bias:0.04). Comparing follow-up FFRi and FFRCT, no false negatives but two false positive cases were found. The overall accuracy was 94.7%, with sensitivity and specificity of 100.0% and 90.0% for identifying lesions <= 0.8 on FFRi. Accuracy, sensitivity, and specificity were 81.5%, 93.3%, and 73.9%, respectively, for identifying significant lesions on baseline FFRi using index FFRCT. Conclusion: FFRCT in STEMI patients close to the index event could identify hemodynamically relevant non-IRA lesions with higher accuracy than FFRi measured at the index PCI, using follow-up FFRi as the reference standard. Early FFRCT in STEMI patients might represent a new application for cardiac CT to improve the identification of patients who benefit most from staged non-IRA revascularization.

Automated summary

This study aimed to evaluate the changes in invasive fractional flow reserve (FFRi) of non-infarction related lesions over time in ST-elevation myocardial infarction (STEMI) patients. The study found that coronary CT angiography-derived FFR (FFRCT) had a higher accuracy in predicting follow-up FFRi compared to baseline FFRi. This suggests that FFRCT could be a valuable tool in identifying hemodynamically relevant non-IRA lesions in STEMI patients.