Long-term prognostic implications of CT angiography-derived fractional flow reserve: Results from the DISCOVER-FLOW...

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Diagnostics

Background:

• The long-term prognostic value of CT angiography-derived fractional flow reserve (FFR_CT) is not well-established.
• This study investigates the long-term outcomes associated with FFR_CT from its initial human trial.

Purpose of the Study:

• To evaluate the long-term prognostic implications of FFR_CT in patients with stable coronary artery disease.
• To compare the predictive performance of FFR_CT with invasive fractional flow reserve (FFR).

Main Methods:

• A cohort of 102 patients (156 vessels) with stable coronary artery disease underwent coronary CT angiography (CCTA) and invasive FFR measurement.
• The primary endpoint was target vessel failure (TVF), encompassing cardiovascular death, target vessel myocardial infarction, and target vessel revascularization.
• Outcome analysis utilized a marginal Cox proportional hazard model based on FFR_CT values.

Main Results:

• Over a median 9.9-year follow-up, 12.8% of vessels experienced TVF.
• FFR_CT ≤0.80 was associated with a significantly higher risk of TVF (HR 2.61).
• In vessels managed conservatively, TVF risk showed an inverse correlation with FFR_CT, and FFR_CT demonstrated predictive accuracy similar to invasive FFR (c-index 0.79 vs 0.71).

Conclusions:

• FFR_CT provides robust long-term risk stratification for patients with stable coronary artery disease.
• The risk continuum identified by FFR_CT mirrors that of invasive FFR, supporting its clinical utility.