Clinical Value of Computational Angiography-derived Fractional Flow Reserve in Stable Coronary Artery Disease

• Published in: Journal of cardiovascular translational research Vol. 16; no. 5; pp. 1166 - 1176
• Main Authors: Leung, Calvin Ka-Lam, Lam, Lok-Yee, Li, Kwan-Yu, Feng, Yundi, Cao, Gaozhen, Wu, Min, Wang, Run, Wu, Mei-Zhen, Ren, Qing-Wen, Yu, Si-Yeung, Tse, Yi-Kei, Li, Hang-Long, Yu, Shuk-Yin, Tse, Hung-Fat, Xu, Bo, Yiu, Kai-Hang
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023
• Subjects: Biomedical Engineering and Bioengineering; Biomedicine; Cardiology; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Fractional Flow Reserve, Myocardial; Human Genetics; Humans; Medicine; Medicine & Public Health; Original Article; Percutaneous Coronary Intervention; Predictive Value of Tests; Treatment Outcome; Computational pressure-flow dynamics; Coronary angiography; Percutaneous coronary intervention; Coronary artery disease; Fractional flow reserve
• ISSN: 1937-5387; 1937-5395
• DOI: 10.1007/s12265-023-10381-x

The utilization of FFR remains low. Our study evaluated the per-vessel prognostic value of computational pressure-flow dynamics-derived FFR (caFFR) among patients with stable coronary artery disease. A total of 3329 vessels from 1308 patients were included and analysed. They were stratified into ischaemic (caFFR ≤ 0.8) and non-ischaemic (caFFR > 0.8) cohorts, and the associations between PCI and outcomes were evaluated. The third cohort comprised all included vessels, and the associations between treatment adherent-to-caFFR (PCI in vessels with caFFR ≤ 0.8 and no PCI in vessels with caFFR > 0.8) and outcomes were evaluated. The primary outcome was VOCE, defined as a composite of vessel-related cardiovascular mortality, non-fatal myocardial infarction, and repeat revascularization. PCI was associated with a lower 3-year risk of VOCE in the ischaemic cohort (HR, 0.44; 95% CI, 0.26–0.74; P  = 0.002) but not in the non-ischaemic cohort. The risk of VOCE was lower in the adherent-to-caFFR group ( n  = 2649) (HR, 0.69; 95% CI, 0.48–0.98; P  = 0.039). Graphical Abstract A novel index that uses coronary angiography images to estimate FFR may have substantial clinical value in guiding management among patients with stable coronary artery disease.