Impact of computed tomography-derived fractional flow reserve on long-term outcomes in patients with stable coronary artery disease: A systematic review and meta-analysis.
Abstract
Background
In patients with coronary artery disease (CAD), both functional and anatomical assessment are required to guide revascularization. Computed tomography-derived fractional flow reserve (FFR-CT) has emerged as a tool to implement both anatomical and non-invasive functional assessment of coronary stenoses in a single setting, but the association with long-term outcomes is still controversial. We aimed to assess the correlation between FFR-CT with long-term outcomes in patients with CAD.
Methods
Reconstructed individual patient data were provided by the authors of a previous report published in a previous issue of the Journal. The primary outcome was study-defined major adverse cardiovascular events (MACE), while secondary outcomes included the single components of the primary outcome. One-stage and two-stage meta-analyses with mixed-effect and random-effect models were conducted, stratifying patients according to FFR-CT thresholds of 0.8. Heterogeneity sources were explored through sensitivity analyses.
Results
Fifteen studies were pooled from the reconstructed data, encompassing a total of 14,437 patients, with 6335 (43.9%) having a FFR-CT<0.8. After a median follow-up of 16.8 (7.2-35.8) months, FFR-CT<0.8 was associated with higher rates of MACE (hazard ratio: 4.93; 95% CI 4.16-5.84; p < 0.001), myocardial infarction (incidence rate ratio [IRR] 4.38; 95% CI 1.16-16.54; p = 0.029), ischemia driven revascularization (IRR 2.90; 95% CI 1.31-6.44; p = 0.009), and any revascularization (IRR 9.62; 95% CI 3.02-30.61; p < 0.001). Results were consistent across sensitivity analyses.
Conclusions
In patients with CAD, an FFR-CT <0.80 is associated with a three-to four-fold increase in MACE, being primarily driven by significant increase in myocardial infarction, ischemia-driven revascularization and any revascularization.