CCTA-derived trans-lesion fractional flow reserve gradient for predicting cardiovascular events after PCI: a...

This study aimed to evaluate the predictive value of pre-interventional coronary CT angiography-derived fractional flow reserve (FFR_CT) in chronic coronary syndrome (CCS) patients after percutaneous coronary intervention (PCI). Additionally, we investigated revascularization completeness using distal FFR_CT (dFFR_CT) and trans-lesion FFR_CT gradient (ΔFFR_CT).

This prospective observational study included 475 patients who underwent CCTA within 90 days before PCI, among whom 97 patients experienced major adverse cardiovascular events (MACEs). Patients were stratified based on dFFR_CT ≤ 0.80 and ΔFFR_CT ≥ 0.22. Completeness of revascularization was assessed by integrating dFFR_CT and ΔFFR_CT. MACE was defined as a composite of cardiovascular death, spontaneous myocardial infarction, and target vessel revascularization. Kaplan-Meier curves were used to describe the cumulative incidence of MACEs.

Both dFFR_CT (HRadjust: 0.006, 95%CI: 0.001-0.057; P < 0.001) and ΔFFR_CT (HRadjust: 34.894, 95%CI: 5.323-228.722, P < 0.001) were independently associated with MACEs. The cumulative incidence of MACEs differed significantly between groups stratified by dFFR_CT (45.3% vs. 20.8%; P = 0.014) and ΔFFR_CT (52.1% vs. 27.4%; P < 0.001). Vessels with dFFR_CT ≤ 0.80 and ΔFFR_CT ≥ 0.22 exhibited a significantly higher risk of MACE than vessels with dFFR_CT ≤ 0.80 and ΔFFR_CT < 0.22 or dFFR_CT > 0.80 (Log-rank: P < 0.001). The incomplete revascularization group, as assessed by both dFFR_CT and ΔFFR_CT, showed the highest risk of MACE (Log-rank: P < 0.001).

ΔFFR_CT effectively predicts MACEs in CCS patients after PCI. Integrating clinical features and hemodynamic characteristics enhances predictive accuracy. Additionally, ΔFFR_CT aids in evaluating the completeness of revascularization.