Related Experiment Video
Updated: Jun 15, 2026
Author Spotlight: Improved Localization and Monitoring of Coronary Flow Reserve Using Modified PLAX View in Mice
Published on: August 25, 2023
Long-term prognostic impact of complete revascularisation defined by CT-derived fractional flow reserve
Kristian Taekker Madsen1, Bjarne Linde Nørgaard2, Kristian Altern Øvrehus3
1Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark kristian.taekker.madsen2@rsyd.dk.
Insights
Complete revascularisation, determined by coronary CT angiography-derived fractional flow reserve (FFRCT), significantly reduces long-term cardiovascular events in stable coronary artery disease patients. This non-invasive approach guides effective treatment strategies for improved patient outcomes.
Area of Science:
- Cardiovascular Imaging and Intervention
- Interventional Cardiology
- Non-invasive Cardiac Diagnostics
Background:
- Long-term benefits of complete revascularisation in coronary artery disease (CAD) remain uncertain.
- Non-invasive methods to assess revascularisation completeness are needed.
- Investigating the prognostic impact of FFRCT-defined complete vs. incomplete revascularisation.
Purpose of the Study:
- To evaluate the long-term prognostic significance of complete revascularisation in stable angina patients.
- To determine if FFRCT can reliably define revascularisation status and guide treatment.
- To assess the association between FFRCT-defined revascularisation and major adverse cardiovascular events.
Main Methods:
- Prospective multicentre study of 900 stable angina patients with coronary CT angiography.
- FFRCT analysis to categorize patients into complete revascularisation, incomplete revascularisation, or normal physiology.
- 7-year follow-up for a primary endpoint of cardiovascular death or spontaneous myocardial infarction.
Main Results:
- Incomplete revascularisation (23%) was associated with a significantly higher risk of the primary endpoint compared to complete revascularisation (19%) and normal physiology (58%).
- Complete revascularisation showed a sustained reduction in cardiovascular death and myocardial infarction over 7 years.
- Associations remained significant after adjusting for plaque burden and persisted beyond 3 years.
Conclusions:
- Complete revascularisation, assessed non-invasively using FFRCT, leads to sustained long-term benefits in stable CAD.
- FFRCT serves as a valuable tool for guiding revascularisation strategies.
- This approach can improve long-term outcomes by identifying patients who benefit most from intervention.
Background:
Complete revascularisation has been associated with improved short-term outcomes in patients with coronary artery disease, but whether these benefits persist long-term and can be defined non-invasively remains uncertain. We investigated the long-term prognostic impact of complete versus incomplete revascularisation determined by coronary CT angiography-derived fractional flow reserve (FFRCT).
Methods:
In this prospective multicentre study, 900 patients with new-onset stable angina and at least one coronary stenosis of 30% or greater on coronary CT angiography were followed for a median of 7 years. FFRCT values were obtained for each vessel, and patients were categorised as completely revascularised (all vessels with FFRCT ≤0.80 revascularised), incompletely revascularised (one or more vessels with FFRCT ≤0.80 not revascularised), or with normal physiology (all vessels with FFRCT >0.80). Early revascularisation was defined as treatment within 90 days of the index scan. Quantitative coronary plaque burden was assessed using artificial intelligence-enabled plaque analysis. The primary endpoint was a composite of cardiovascular death or spontaneous myocardial infarction.
Results:
Of 900 patients, 210 (23%) were classified as incompletely revascularised, 167 (19%) as completely revascularised and 523 (58%) as having normal physiology. The primary endpoint occurred in 34 of 210 (16.2%) incompletely revascularised patients, 13 of 167 (7.8%) completely revascularised patients and 30 of 523 (5.7%) with normal physiology. Incomplete revascularisation was associated with higher risk compared with complete revascularisation (HR 2.33, 95% CI 1.23 to 4.42; p=0.01) and normal physiology (HR 3.54, 95% CI 2.16 to 5.81; p<0.001). These associations remained significant after adjustment for total plaque burden, and the risk difference persisted beyond 3 years of follow-up.
Conclusion:
Complete revascularisation defined by CT-derived fractional flow reserve was associated with a sustained reduction in cardiovascular death and spontaneous myocardial infarction over 7 years, supporting its potential role as a non-invasive tool to guide revascularisation strategies in stable coronary artery disease.
