Discordance between Invasive and Non-Invasive Coronary Angiography: An In-Depth Functional and Anatomical Analysis

A 79-year-old male with chronic coronary syndrome with complex coronary artery disease was included in the first-in-man trial of surgical revascularization guided solely by coronary computed tomography angiography (CCTA) and fractional flow reserve derived from CCTA (FFRCT). In CCTA analysis, the patient had calcified three-vessel disease, with a global anatomical SYNTAX score of 27. In contrast, in the initial FFRCT, only the ramus intermediate stenosis was physiologically significant, with no other vessels having an FFRCT <= 0.80 (functional SYNTAX score of 2). Discordance between the results of the CCTA and FFRCT necessitated an in-depth analysis by using both invasive and non-invasive coronary angiography. Angiography-derived fractional flow reserve (FFR) confirmed that the stenosis in the proximal left anterior descending artery (LAD) was physiologically significant, while it remained functionally negative in the second assessment of FFRCT. Extensive calcification is the most plausible explanation for the underestimation of the stenosis of proximal LAD in CCTA-derived FFR technology.

Automated summary

A 79-year-old male patient with chronic coronary syndrome and complex coronary artery disease was enrolled in a clinical trial assessing the use of coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) for surgical revascularization. Discordance between CCTA and initial FFRCT results required further analysis using invasive and non-invasive coronary angiography. The findings revealed that the stenosis in the proximal left anterior descending artery (LAD) was physiologically significant in angiography-derived fractional flow reserve (FFR), while it remained functionally negative in the second assessment of FFRCT, possibly due to extensive calcification.