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Value of CT-derived Fractional Flow Reserve in the Context of Outpatient Cardiac CT in Germany: A Propensity Score
Dennis Rottländer1,2, Cara Fischer2, Yazan Mohsen1
1Krankenhaus Porz am Rhein, Cardiology, NRW, Germany, Cologne.
Purpose:
Coronary artery disease (CAD) remains one of the leading causes of death in Germany. Since outpatient reimbursement for cardiac computed tomography angiography (CCTA) became available in 2024, non-invasive diagnostics have gained importance. CT-derived fractional flow reserve (FFR-CT) may increase the specificity of CCTA and reduce invasive procedures.
Materials And Methods:
In this retrospective analysis, 640 consecutive patients with coronary stenosis >25% were included in outpatient CCTA. Among them, 107 underwent additional FFR-CT. After propensity score matching, two cohorts of 105 patients each were available for comparison. The primary endpoint was the positive predictive value (PPV) for hemodynamically relevant stenoses.
Results:
Based on propensity score matching, FFR-CT showed a PPV of 88% compared to 73% in the group without FFR-CT. Patients with nonpathological FFR-CT results were mainly managed conservatively, whereas pathological values led to revascularization in more than 70%. In the control group without FFR-CT, invasive coronary angiographies without coronary intervention were significantly more frequent (27%). Correlation between FFR-CT and invasive FFR was strong (r = 0.92; ICC = 0.95).
Conclusion:
Integration of FFR-CT in outpatient CCTA seems to improve diagnostic accuracy and reduce invasive procedures. It has the potential to combine anatomical and functional information and optimize treatment decisions in stable CAD.
Key Points:
· FFR-CT has the potential to increase diagnostic accuracy and reduce invasive coronary angiographies.. · FFR-CT has a higher positive predictive value than CCTA.. · The correlation between FFR-CT and invasive FFR was high.. · In cases of pathological FFR-CT, revascularization was performed in >70% of patients.
Citation Format:
· Rottländer D, Fischer C, Mohsen Y et al. Value of CT-derived Fractional Flow Reserve in the Context of Outpatient Cardiac CT in Germany: A Propensity Score Matched Analysis. Rofo 2025; DOI 10.1055/a-2760-5485.
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