LAUSR

AIMS The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia. METHODS In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and fractional flow reserve (FFR) measurement. CCTA-derived %FMM with diameter stenosis≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR≤0.80. RESULTS The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics = 0.74; %FMM-50, 0.73; angiographic scores, 0.68-0.77). The frequency of FFR≤0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p < 0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR≤0.80 were ≥36.3% and ≥8.7%, respectively. Using these cutoffs, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 81%, 55%, 3%, 67%, 71%, and of %FMM-70 were 67%, 78%, 82%, 61%, 71%. CONCLUSION %FMM was comparable to angiographic scores for prediction of functional stenosis defined by FFR≤0.80. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of the functional significance of vessel.