Clinical impact of coronary computed tomography angiography-derived fractional flow reserve on Japanese population in the ADVANCE registry

Yasutsugu Shiono, Hitoshi Matsuo, Tomohiro Kawasaki, Tetsuya Amano, Hironori Kitabata, Takashi Kubo, Yoshihiro Morino, Shunichi Yoda, Tomohiro Sakamoto, Hiroshi Ito, Junya Shite, Hiromasa Otake, Nobuhiro Tanaka, Mitsuyasu Terashima, Kazushige Kadota, Manesh R. Patel, Koen Nieman, Campbell Rogers, Bjarne L. Nørgaard, Jeroen J. BaxGilbert L. Raff, Kavitha M. Chinnaiyan, Daniel S. Berman, Timothy A. Fairbairn, Lynne M. Hurwitz Koweek, Jonathon Leipsic, Takashi Akasaka

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7 Citations (Scopus)


Background: Coronary computed tomography angiography (cCTA)-derived fractional flow reserve (FFRCT) is a promising diagnostic method for the evaluation of coronary artery disease (CAD). However, clinical data regarding FFRCT in Japan are scarce, so we assessed the clinical impact of using FFRCT in a Japanese population. Methods and Results: The ADVANCE registry is an international prospective FFRCT registry of patients suspected of CAD. Of 5,083 patients, 1,829 subjects enrolled from Japan were analyzed. Demographics, symptoms, cCTA, FFRCT, treatment strategy, and 90-day major cardiovascular events (MACE) were assessed. Reclassification of treatment strategy between cCTA alone and cCTA+FFRCT occurred in 55.8% of site investigations and in 56.9% in the core laboratory analysis. Patients with positive FFR (FFRCT ≤0.80) were less likely to have non-obstructive disease on invasive coronary angiography than patients with negative FFR (FFRCT >0.80) (20.5% vs. 46.1%, P=0.0001). After FFRCT, 67.0% of patients with positive results underwent revascularization, whereas 96.1% of patients with negative FFRCT were medically treated. MACE occurred in 5 patients with positive FFRCT, but none occurred in patients with negative FFRCT within 90 days. Conclusions: In this Japanese population, FFRCT modified the treatment strategy in more than half of the patients. FFRCT showed potential for stratifying patients suspected of CAD properly into invasive or non-invasive management pathways.

Original languageEnglish
Pages (from-to)1293-1301
Number of pages9
JournalCirculation Journal
Issue number6
Publication statusPublished - 2019


  • Coronary CT angiography
  • Coronary artery disease
  • FFR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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