- Design
- Nationwide retrospective cohort, 3-year follow-up
- Population
- 7,836 patients with stable chest pain having CT coronary angiography with FFR-CT in England
- Primary outcome
- Myocardial infarction, cardiovascular death, all-cause death, revascularisation
- Effect
- FFR-CT ≤0.7: adjusted HR for MI 2.94–3.39; ≤0.5: adjusted HR for CV death 2.92
This English cohort followed 7,836 patients at 27 sites who had coronary CT with clinically indicated FFR-CT, a computed estimate of whether a narrowing limits flow, for stable chest pain. Follow-up was three years.
After adjusting for risk factors and stenosis severity, an FFR-CT 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. When the value across the stenosis was normal, the three-year rate of infarction or cardiovascular death was 1.5%. Adding FFR-CT improved risk prediction only slightly (C index rose by 0.012).
FFR-CT is already used to decide on invasive testing. This suggests the number also says something about prognosis, but it is observational and tells you nothing about whether acting on it improves outcomes.
- Read the stenosis-specific FFR-CT value, not just the stenosis grade, in CT reports.
- Treat a value of 0.7 or below as a marker of higher infarction risk worth intensifying prevention for.
- A normal stenosis-specific value was linked to a low three-year event rate; this can inform reassurance.
- Do not refer for revascularisation on prognostic grounds from this study alone.
Why it matters
A test ordered for diagnosis is also carrying prognostic information that is often ignored.
Don't overread it
This is an association; it does not show that treating a low FFR-CT value prevents events.
The statistics, in plain English
Adjusted hazard ratios around 3 mean roughly triple the risk after accounting for other factors. The C index improvement of 0.012 is small: FFR-CT adds a little to risk prediction, not a lot.
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