Clinical and prognostic incremental value of FFRCT in screening of patients with obstructive coronary artery disease

Abstract

Background

Coronary computed tomography angiography (CCTA) -derived fractional flow reserve (FFR_CT) is recommended to evaluate the functional consequences of obstructive coronary artery disease (OCAD). Real-world incremental impacts of FFR_CT use still remains under debate.

Methods

1601 patients with suspected OCAD on CCTA (>50 ​% stenosis), including 808 (50.5 ​%) patients evaluated by FFR_CT, were included from a 2013–2021 registry. Propensity adjusted impacts of FFR_CT use on rates of invasive coronary angiography (ICA), myocardial revascularization (MR) and post MR major adverse cardiac events (MACE) were reported, including a sensitivity analysis in severe OCAD (>70 ​% stenosis) (n ​= ​450). Accuracy of numerical and comprehensive FFR_CT interpretations in selection of patients requiring a MR were also compared.

Results

1160 (72,5 ​%) ICA, 559 (34.9 ​%) MR and 137 (24.5 ​%) post MR MACE occurred at 4.7 ​± ​1.9 years. FFR_CT use was independently associated with decreased rate of ICA and MR (OR: 0.66; 95 ​% CI 0.53–0.83, p ​< ​0.001 and OR: 0.71; 95 ​% CI 0.58–0.88, p ​< ​0.01, respectively). Compared to the numerical interpretation, the FFR_CT comprehensive assessment increased the ratio of MR per ICA (61.7 ​% vs 50.1 ​%, p ​< ​0.01) and was more accurate in selection of patients requiring MR. FFR_CT reduced post MR MACE (OR: 0.64; 95 ​% CI 0.43–0.96, p ​< ​0.05). All these associations were no longer observed in severe OCAD.

Conclusion

Implementing FFR_CT in OCAD patients reduces ICA use, improves selection of patients requiring MR and reduces post MR MACE. However, these incremental values of FFRCT were no longer observed in severe OCAD.