Clinical and prognostic incremental value of FFRCT in screening of patients with obstructive coronary artery disease

Background: Coronary computed tomography angiography (CCTA) -derived fractional flow reserve (FFRCT) is recommended to evaluate the functional consequences of obstructive coronary artery disease (OCAD). Real-world incremental impacts of FFRCT use still remains under debate. Methods: 1601 patients with suspected OCAD on CCTA (>50 % stenosis), including 808 (50.5 %) patients evaluated by FFRCT, were included from a 2013-2021 registry. Propensity adjusted impacts of FFRCT use on rates of invasive coronary angiography (ICA), myocardial revascularization (MR) and post MR major adverse cardiac events (MACE) were reported, including a sensitivity analysis in severe OCAD (>70 % stenosis) (n = 450). Accuracy of numerical and comprehensive FFRCT interpretations in selection of patients requiring a MR were also compared. Results: 1160 (72,5 %) ICA, 559 (34.9 %) MR and 137 (24.5 %) post MR MACE occurred at 4.7 +/- 1.9 years. FFRCT use was independently associated with decreased rate of ICA and MR (OR: 0.66; 95 % CI 0.53-0.83, p < 0.001 and OR: 0.71; 95 % CI 0.58-0.88, p < 0.01, respectively). Compared to the numerical interpretation, the FFRCT comprehensive assessment increased the ratio of MR per ICA (61.7 % vs 50.1 %, p < 0.01) and was more accurate in selection of patients requiring MR. FFRCT reduced post MR MACE (OR: 0.64; 95 % CI 0.43-0.96, p < 0.05). All these associations were no longer observed in severe OCAD. Conclusion: Implementing FFRCT in OCAD patients reduces ICA use, improves selection of patients requiring MR and reduces post MR MACE. However, these incremental values of FFRCT were no longer observed in severe OCAD.