Coronary Artery Bypass Grafting Based on Computed Tomography-Derived Fractional Flow Reserve vs Angiography (CABG-COREA trial): Early Results.

Abstract

This randomized trial was designed to compare 1-year outcomes in patients who received revascularization on the basis of computed tomography-derived fractional flow reserve (CT-FFR) vs quantitative coronary angiography (QCA). In this early analysis, early angiographic and clinical outcomes were compared. A total of 106 patients were randomized to undergo coronary artery bypass grafting on the basis of CT-FFR (n = 53) or QCA (n = 53). Complete revascularization was achieved for coronary arteries with CT-FFR ≤0.78 (CT-FFR group) or those with QCA stenosis (>70% stenosis for left and ≥90% stenosis for right coronary artery territories; QCA group). Angiography was performed at median 1 (1-1) postoperative day in all patients. Angiographic findings of graft flow were categorized as perfectly patent, competitive (bidirectionally or unidirectionally competitive), or occluded. There were no differences in patient characteristics between the groups. The average number of revascularized coronary arteries per patient was 3.7 ± 0.8 in the CT-FFR group and 3.5 ± 0.7 in the QCA group (P = .089). The median difference in expected anastomosis sites was 2 (1-3). There was no operative mortality and no difference in morbidities between the groups. The number of perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts was 167 (85.2%), 10 (5.1%), and 19 (9.7%), respectively, in the CT-FFR group (n = 196) and 133 (72.7%), 23 (12.6%), and 27 (14.8%), respectively, in the QCA group (n = 183). There was a significant difference in the number of perfectly patent grafts between the groups (P = .007). The average number of distal anastomoses was similar between the groups. However, the number of competitive grafts was significantly reduced in the CT-FFR group compared with the QCA group.