Fractional Flow Reserve and Fractional Flow Reserve Gradient From CCTA for Predicting Future Coronary Events.

Background: Coronary computed tomography angiography-derived fractional flow reserve (FFR _CT ) is a per-vessel index reflecting cumulative hemodynamic burden while coronary events occur in focal lesions.
Objectives: The authors sought to evaluate the additive prognostic value of the local gradient of FFR _CT (FFR _CT gradient) in addition to FFR _CT to predict future coronary events.
Methods: The current study included 245 patients (634 vessels) who underwent coronary computed tomography angiography within 6 to 36 months before the index angiography, of which 209 vessels had future coronary events and 425 vessels did not. Future coronary events were defined as a composite of vessel-specific myocardial infarction or urgent revascularization during a mean interval of 1.5 years. Pre-existing disease patterns were classified according to FFR _CT of ≤0.80 and FFR _CT gradient of ≥0.025/mm.
Results: Both FFR _CT (per 0.01 decrease; adjusted HR: 1.040; 95% CI: 1.029-1.051; P  < 0.001) and FFR _CT gradient (per 0.01 increase; adjusted HR: 1.144; 95% CI: 1.101-1.190; P  < 0.001) were significantly associated with the risk of future coronary events. Lesions with FFR _CT gradient of ≥0.025/mm showed significantly higher risk of future coronary events than those with FFR _CT gradient of <0.025/mm in both the FFR _CT >0.80 (49.2% vs 30.1%; HR: 2.069; 95% CI: 1.265-3.385; P  = 0.004) and FFR _CT  ≤0.80 groups (60.9% vs 38.3%; HR: 1.988; 95% CI: 1.317-2.999; P =0 .001). Adding FFR _CT gradient into the model with FFR _CT alone showed significantly increased predictability of future coronary events (global chi-square: 45.8 vs 39.9; P  = 0.015).
Conclusions: Patients with high FFR _CT gradient showed increased risk of future coronary events irrespective of FFR _CT . Integrating both FFR _CT and FFR _CT gradient showed incremental predictability of future coronary events compared with FFR _CT alone. (Prediction and Validation of Clinical Course of Coronary Artery Disease With CT-Derived Non-Invasive Hemodynamic Phenotyping and Plaque Characterization [DESTINY Study]; NCT04794868).
Competing Interests: The current study was supported by the internal research funds provided from the Heart Vascular Stroke Institute, Samsung Medical Center (OTX0004011). Other than providing financial support, the sponsors were not involved with design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Dr Hahn has received institutional research grants from the National Evidence-Based Healthcare Collaborating Agency, Ministry of Health and Welfare, Korea; Abbott Vascular; Biosensors; Boston Scientific; Daiichi-Sankyo; Donga-ST; Hanmi Pharmaceutical; and Medtronic Inc. Dr Gwon has received institutional research grants from Boston Scientific, Genoss, and Medtronic Inc. Dr J.-M. Lee has received institutional research grants from Abbott Vascular, Boston Scientific, Philips Volcano, Terumo Corporation, Zoll Medical, and Donga-ST. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)