Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis.

Journal Article (Journal Article;Systematic Review)

OBJECTIVES: To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). METHODS: We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as 'all-cause mortality (ACM) or myocardial infarction (MI)' at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. RESULTS: Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). CONCLUSIONS: The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

Full Text

Duke Authors

Cited Authors

  • Nørgaard, BL; Gaur, S; Fairbairn, TA; Douglas, PS; Jensen, JM; Patel, MR; Ihdayhid, AR; Ko, BSH; Sellers, SL; Weir-McCall, J; Matsuo, H; Sand, NPR; Øvrehus, KA; Rogers, C; Mullen, S; Nieman, K; Parner, E; Leipsic, J; Abdulla, J

Published Date

  • February 2022

Published In

Volume / Issue

  • 108 / 3

Start / End Page

  • 194 - 202

PubMed ID

  • 34686567

Pubmed Central ID

  • PMC8762006

Electronic International Standard Serial Number (EISSN)

  • 1468-201X

Digital Object Identifier (DOI)

  • 10.1136/heartjnl-2021-319773


  • eng

Conference Location

  • England