Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis

Abstract Objectives The addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of Coronary CT Angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD). Methods This retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACE) during the one-year follow-up using chi-square tests for independence. Kaplan-Meier curves were used to visualize the occurrence of safety outcomes over time. Results 360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA-group and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA) and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA and three (2.2%) SPECT (p<0.001 for all three options). The revascularization rate after ICA was similar between groups (p=0.15). However, patients in the CCTA-group more often underwent revascularization (p=0.007). Conclusion Addition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after one year.Clinical decisions and follow upSignificant LAD lesion, negative FFRCT