Objectives <p>The long-term prognostic significance of the coronary computed tomography angiography (CCTA)–derived fractional flow reserve (CT-FFR) for non-obstructive coronary artery disease (CAD) is uncertain. We aimed to investigate the additional prognostic value of CT-FFR beyond CCTA–defined atherosclerotic burden for long-term outcomes.</p> Materials and methods <p>Consecutive patients with suspected stable CAD were candidates for this retrospective cohort study. Deep-learning-based vessel-specific CT-FFR was calculated. All patients enrolled were followed for at least 5 years. The primary outcome was major adverse cardiovascular events (MACE). Predictive abilities for MACE were compared among three models (model 1, constructed using clinical variables; model 2, model 1 + CCTA–derived atherosclerotic burden (Leiden risk score and segment involvement score); and model 3, model 2 + CT-FFR).</p> Results <p>A total of 1944 patients (median age, 59 (53–65) years; 53.0% men) were included. During a median follow-up time of 73.4 (71.2–79.7) months, 64 patients (3.3%) experienced MACE. In multivariate-adjusted Cox models, CT-FFR ≤ 0.80 (HR: 7.18; 95% CI: 4.25–12.12; <i>p</i> < 0.001) was a robust and independent predictor for MACE. The discriminant ability was higher in model 2 than in model 1 (C-index, 0.76 vs. 0.68; <i>p</i> = 0.001) and was further promoted by adding CT-FFR to model 3 (C-index, 0.83 vs. 0.76; <i>p</i> < 0.001). Integrated discrimination improvement (IDI) was 0.033 (<i>p</i> = 0.022) for model 2 beyond model 1. Of note, compared with model 2, model 3 also exhibited improved discrimination (IDI = 0.056; <i>p</i> < 0.001).</p> Conclusions <p>In patients with non-obstructive CAD, CT-FFR provides robust and incremental prognostic information for predicting long-term outcomes. The combined model including CT-FFR and CCTA–defined atherosclerotic burden exhibits improved prediction abilities, which is helpful for risk stratification.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Prognostic significance of the CT-fractional flow reserve (FFR) in non-obstructive coronary artery disease for long-term outcomes merits further investigation.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Our data strongly emphasized the independent and additional predictive value of CT-FFR beyond coronary CTA-defined atherosclerotic burden and clinical risk factors.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>The new combined predictive model incorporating CT-FFR can be satisfactorily used for risk stratification of patients with non-obstructive coronary artery disease by identifying those who are truly suitable for subsequent high-intensity preventative therapies and extensive follow-up for prognostic reasons.</i></p> Graphical Abstract <p></p>

Long-term prognostic value of the CT-derived fractional flow reserve combined with atherosclerotic burden in patients with non-obstructive coronary artery disease

期刊论文
发表日期：

2025年6月13日

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Zhiqiang Wang,
Zhennan Li,
Tingfeng Xu,
Minxian Wang,
Lei Xu,
Yong Zeng

摘要

Objectives

The long-term prognostic significance of the coronary computed tomography angiography (CCTA)–derived fractional flow reserve (CT-FFR) for non-obstructive coronary artery disease (CAD) is uncertain. We aimed to investigate the additional prognostic value of CT-FFR beyond CCTA–defined atherosclerotic burden for long-term outcomes.

Materials and methods

Consecutive patients with suspected stable CAD were candidates for this retrospective cohort study. Deep-learning-based vessel-specific CT-FFR was calculated. All patients enrolled were followed for at least 5 years. The primary outcome was major adverse cardiovascular events (MACE). Predictive abilities for MACE were compared among three models (model 1, constructed using clinical variables; model 2, model 1 + CCTA–derived atherosclerotic burden (Leiden risk score and segment involvement score); and model 3, model 2 + CT-FFR).

Results

A total of 1944 patients (median age, 59 (53–65) years; 53.0% men) were included. During a median follow-up time of 73.4 (71.2–79.7) months, 64 patients (3.3%) experienced MACE. In multivariate-adjusted Cox models, CT-FFR ≤ 0.80 (HR: 7.18; 95% CI: 4.25–12.12; p < 0.001) was a robust and independent predictor for MACE. The discriminant ability was higher in model 2 than in model 1 (C-index, 0.76 vs. 0.68; p = 0.001) and was further promoted by adding CT-FFR to model 3 (C-index, 0.83 vs. 0.76; p < 0.001). Integrated discrimination improvement (IDI) was 0.033 (p = 0.022) for model 2 beyond model 1. Of note, compared with model 2, model 3 also exhibited improved discrimination (IDI = 0.056; p < 0.001).

Conclusions

In patients with non-obstructive CAD, CT-FFR provides robust and incremental prognostic information for predicting long-term outcomes. The combined model including CT-FFR and CCTA–defined atherosclerotic burden exhibits improved prediction abilities, which is helpful for risk stratification.

Key Points

Question Prognostic significance of the CT-fractional flow reserve (FFR) in non-obstructive coronary artery disease for long-term outcomes merits further investigation.

Findings Our data strongly emphasized the independent and additional predictive value of CT-FFR beyond coronary CTA-defined atherosclerotic burden and clinical risk factors.

Clinical relevance The new combined predictive model incorporating CT-FFR can be satisfactorily used for risk stratification of patients with non-obstructive coronary artery disease by identifying those who are truly suitable for subsequent high-intensity preventative therapies and extensive follow-up for prognostic reasons.

Graphical Abstract