2020 J Clin Med (Stress-CTP RIPCORD)

Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived
fractional flow reserve (FFRCT) are functional techniques that can be added to coronary computed
tomography angiography (cCTA) to improve the management of patients with suspected coronary
artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess
the impact of their availability on the management of patients with suspected CAD scheduled
for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined
as optimal medical therapy (OMT) or revascularization and was recorded for the following
strategies: cCTA alone, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP. In 291
prospectively enrolled patients, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP
showed a similar rate of reclassification of cCTA findings when FFRCT and Stress-CTP were added
to cCTA. cCTA, cCTA+FFRCT, cCTA+Stress-CTP and cCTA+FFRCT+Stress-CTP showed a rate
of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP
and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, and a rate of
agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP
and cCTA+FFRCT+Stress-CTP vs cCTA and cCTA+FFRCT: p < 0.01), respectively, with an eective
radiation dose (ED) of 2.9  1.3 mSv, 2.9  1.3 mSv, 5.9  2.7 mSv, and 3.1  2.1 mSv. The addition
of FFRCT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a
sequential strategy with cCTA+FFRCT+Stress-CTP represents the best compromise in terms of clinical
impact and radiation exposure.