Computed Tomography-Derived Fractional Flow Reserve in Patients With Chronic Coronary Syndrome: A Real-World Cohort...

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Chronic coronary syndrome (CCS) diagnosis often involves invasive coronary angiography.
• Non-invasive imaging like computed tomography (CT) angiography is increasingly used.
• CT-derived fractional flow reserve (FFRCT) offers functional information non-invasively.

Purpose of the Study:

• To evaluate the outcomes of CT angiography with optional FFRCT in patients with intermediate-range coronary artery disease.
• To assess the safety and prognostic value of FFRCT in non-emergent CCS patients.
• To determine if FFRCT can help defer invasive coronary angiography.

Main Methods:

• 743 patients with suspected CCS were included.
• Patients were stratified into high-risk and low-intermediate risk groups.
• Outcomes included unstable angina, unplanned revascularization, myocardial infarction, and all-cause mortality over a mean 2.2-year follow-up.

Main Results:

• Deferred invasive coronary angiography was safe in both low-intermediate and high-risk groups, with comparable adverse event rates (1.4% vs 2.6%).
• In high-risk patients, FFRCT >0.80 showed a low adverse event rate (3.3%) compared to those without additional testing (1.4%).
• The study found no significant difference in adverse events between high-risk patients with FFRCT >0.80 and those who underwent no additional testing (P = 0.79).

Conclusions:

• CT-derived fractional flow reserve >0.8 is associated with an excellent prognosis.
• CT angiography with optional FFRCT enables the safe cancellation of invasive coronary angiography in high-risk CCS patients.
• Non-invasive FFRCT can effectively guide clinical decision-making and reduce the need for invasive procedures.