Pre-PCI CT-FFR Predicts Target Vessel Failure After Stent Implantation

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
• Accurate prediction of target vessel failure (TVF) after PCI is crucial for patient outcomes.
• Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) is an emerging non-invasive tool.

Purpose of the Study:

• To evaluate the predictive value of pre-PCI CT-FFR for TVF after stent implantation.
• To determine the optimal CT-FFR cutoff value for predicting TVF.
• To assess the added value of CT-FFR and stent information in risk stratification models.

Main Methods:

• Retrospective analysis of 429 patients undergoing PCI and stent implantation.
• CT-FFR values were measured using a dedicated workstation.
• TVF was defined as cardiac death, target vessel myocardial infarction, or target vessel revascularization (TVR).
• Log-rank maximization method identified the CT-FFR cutoff value.

Main Results:

• The cumulative incidence of TVF was 7.9% during a median follow-up of 64 months.
• A pre-PCI CT-FFR cutoff of 0.74 independently predicted TVF (HR: 2.61) and TVR (HR: 3.63).
• Pre-PCI CT-FFR significantly improved TVF reclassification compared to clinical risk factors (NRI: 0.424, P <0.001).
• Integrating stent information further enhanced TVF prediction (C-statistic: 0.711, P =0.001).

Conclusions:

• Pre-PCI CT-FFR ≤0.74 is an independent predictor of TVF and TVR.
• Combining clinical data, pre-PCI CT-FFR, and stent information provides superior risk stratification for patients undergoing stent implantation.