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Objective <p>This study aimed to evaluate the predictive value of pre-interventional coronary CT angiography-derived fractional flow reserve (FFR<sub>CT</sub>) in chronic coronary syndrome (CCS) patients after percutaneous coronary intervention (PCI). Additionally, we investigated revascularization completeness using distal FFR<sub>CT</sub> (dFFR<sub>CT</sub>) and trans-lesion FFR<sub>CT</sub> gradient (ΔFFR<sub>CT</sub>).</p> Method <p>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<sub>CT</sub> ≤ 0.80 and ΔFFR<sub>CT</sub> ≥ 0.22. Completeness of revascularization was assessed by integrating dFFR<sub>CT</sub> and ΔFFR<sub>CT</sub>. 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.</p> Results <p>Both dFFR<sub>CT</sub> (HRadjust: 0.006, 95%CI: 0.001–0.057; <i>P</i> &lt; 0.001) and ΔFFR<sub>CT</sub> (HRadjust: 34.894, 95%CI: 5.323-228.722, <i>P</i> &lt; 0.001) were independently associated with MACEs. The cumulative incidence of MACEs differed significantly between groups stratified by dFFR<sub>CT</sub> (45.3% vs. 20.8%; <i>P</i> = 0.014) and ΔFFR<sub>CT</sub> (52.1% vs. 27.4%; <i>P</i> &lt; 0.001). Vessels with dFFR<sub>CT</sub> ≤ 0.80 and ΔFFR<sub>CT</sub> ≥ 0.22 exhibited a significantly higher risk of MACE than vessels with dFFR<sub>CT</sub> ≤ 0.80 and ΔFFR<sub>CT</sub> &lt; 0.22 or dFFR<sub>CT</sub> &gt; 0.80 (Log-rank: <i>P</i> &lt; 0.001). The incomplete revascularization group, as assessed by both dFFR<sub>CT</sub> and ΔFFR<sub>CT</sub>, showed the highest risk of MACE (Log-rank: <i>P</i> &lt; 0.001).</p> Conclusion <p>ΔFFR<sub>CT</sub> effectively predicts MACEs in CCS patients after PCI. Integrating clinical features and hemodynamic characteristics enhances predictive accuracy. Additionally, ΔFFR<sub>CT</sub> aids in evaluating the completeness of revascularization.</p>

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

  • 期刊论文

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  • 发表日期：

    2026年4月25日

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  • Ying Wang,
  • Kui Sun,
  • Zihan Gao,
  • Congshan Ji,
  • Ximing Wang

摘要

Objective

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

Method

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 dFFRCT ≤ 0.80 and ΔFFRCT ≥ 0.22. Completeness of revascularization was assessed by integrating dFFRCT and ΔFFRCT. 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.

Results

Both dFFRCT (HRadjust: 0.006, 95%CI: 0.001–0.057; P < 0.001) and ΔFFRCT (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 dFFRCT (45.3% vs. 20.8%; P = 0.014) and ΔFFRCT (52.1% vs. 27.4%; P < 0.001). Vessels with dFFRCT ≤ 0.80 and ΔFFRCT ≥ 0.22 exhibited a significantly higher risk of MACE than vessels with dFFRCT ≤ 0.80 and ΔFFRCT < 0.22 or dFFRCT > 0.80 (Log-rank: P < 0.001). The incomplete revascularization group, as assessed by both dFFRCT and ΔFFRCT, showed the highest risk of MACE (Log-rank: P < 0.001).

Conclusion

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