FFR-CT predicted myocardial infarction over three years, beyond stenosis severity

Design

Nationwide retrospective cohort, 27 English sites, 3-year follow-up

Population

7,836 patients with stable coronary artery disease who had CT angiography with FFR-CT

Primary outcome

MI, cardiovascular death, all-cause death and revascularisation

Effect

FFR-CT ≤0.7: adjusted HR for MI 2.94–3.39; ≤0.5: adjusted HR for CV death 2.92; normal value 1.5% MI or CV death at 3 years

This English nationwide cohort followed 7,836 patients with stable chest pain who had coronary CT angiography with clinically requested FFR-CT analysis at 27 sites between 2017 and 2020. Median age was 63 and 37% were women. Investigators related the lowest per-patient FFR-CT value to individual outcomes over three years.

Risk rose as FFR-CT fell. After adjusting for risk factors and CAD-RADS stenosis grade, a stenosis-specific value of 0.7 or less was associated with about three times the risk of myocardial infarction, and 0.5 or less with about three times the risk of cardiovascular death. A value of 0.67 was the best single risk threshold. When the stenosis-specific value was normal, the three-year rate of MI or cardiovascular death was 1.5%. Adding FFR-CT to a risk-factor and stenosis model improved discrimination only modestly (C index 0.783, a gain of 0.012).

FFR-CT has been used mainly to decide who goes to the catheter laboratory. This shows it also carries prognostic information, and supports using a normal value as reassurance. It is observational, and the revascularisation association partly reflects clinicians acting on the result.

• Read the stenosis-specific FFR-CT value, not only the anatomical stenosis grade, when counselling on risk.
• A normal stenosis-specific FFR-CT carried a low three-year rate of MI or cardiovascular death (1.5%) in this cohort.
• Values of 0.7 or below were associated with about three times the risk of MI after adjustment; consider intensifying preventive therapy in these patients.
• Distal and stenosis-specific values disagreed in over a third of patients; know which one a report gives.
• FFR-CT access in India is limited; where unavailable, anatomical CT and functional testing remain the standard route.

Why it matters

It moves FFR-CT from a gatekeeper for angiography to a prognostic number worth acting on in clinic.

Don't overread it

This is an association; it does not show that revascularising a low FFR-CT lesion prevents infarction.

The statistics, in plain English

An adjusted hazard ratio of about 3 means that, after accounting for risk factors and how narrow the artery looked, people with FFR-CT of 0.7 or less had their heart attacks at roughly three times the rate. The C index measures how well a model ranks who will have an event (0.5 is chance, 1.0 is perfect); a gain of 0.012 is real but small.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.