CT-FFR in predicting future cardiovascular events

Abstract

Abstract Background Computational fluid dynamics offer a non-invasive way for functional assessment of coronary stenosis in CT-FFR. Currently, minimal FFR thresholds used for determining ischemia were established in invasive coronary angiography. It remains unknown whether minimal absolute CT-FFR values are the most adequate tool for predicting future cardiovascular events. Methods This analysis enrolled 605 of 767 consecutive patients with suspected CAD undergoing CCTA from 2005 to 2007. Of the 161 (21%) patients excluded, image artifacts were the most common cause (97), followed by software error (43) and chronic total occlusion in (15). CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) by an experienced observer. CT-FFR values were measured at the proximal and distal end of each coronary segment and the maximum drop in CT-FFR (ΔFFR) over one segment recorded, respectively. Follow up data included major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, cardiovascular death) and revascularization (PCI or CABG). Results This study included 605 patients (60±11 years, 61.2% men) with minimal CT-FFR 0.81±0.14. Mean ΔFFR was 0.13±0.11. MACE occurred in 24 (4.0%) cases, revascularization in 66 (10.9%) during a median follow up of 2823 days (7–8 years). The area under the Receiver operator characteristic (ROC) curve was 0.887 for revascularization during follow up and 0.608 for MACE during follow up. AUC for the combined end point of MACE and revascularization was 0.806. Conclusion Maximum drop in CT-FFR (ΔFFR) is a good predictor for future revascularization but less useful in predicting MACE. This underlines the current use of CT-FFR in guiding treatment decisions. Funding Acknowledgement Type of funding sources: None.