Impact of FFRCT analysis on computed tomography screening of obstructive coronary artery disease: a propensity score adjusted analysis of a tertiary hospital registry

Background/Introduction: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by guidelines for the evaluation of obstructive coronary artery disease (OCAD). However, real-world impact of selective use of FFRCT in patients with suspected OCAD by CCTA on subsequent invasive coronary angiography (ICA) and revascularization remains unclear. Purpose: Assess the impact and diagnostic accuracy of FFRCT interpretation in patients with suspected OCAD by CCTA on downstream ICA and revascularization. Methods: A 2013–2021 tertiary hospital registry analysis of patients with suspected OCAD on CCTA, defined as at least one stenosis of >50% in any vessel. A propensity score adjusted logistic regression analysis assessed the impact of FFRCT on ICA and revascularization. Diagnostic accuracies of a numerical interpretation of FFRCT, defining lowest distal value 0.8 as a possible need for revascularization, and a comprehensive interpretation of FFRCT, taking into account translesional gradient and anatomical distribution, were compared. Results: From a registry of 7541 patients, suspected OCAD derived from CCTA was reported in 1601 cases, including 808 (50.5%) patients evaluated by FFRCT. ICA was performed in 1160 (72.5%) and revascularization in 559 (34.9%) patients. Overall proportion of ICA decreased from 77.2 to 67.8% with FFRCT use (chi2 p < 0.01). After propensity score weighting, FFRCT use was independently associated with decreased ICA (OR: 0.67; 95% CI 0.53–0.84, p < 0.001) and with an increased rate of myocardial revascularization (OR: 1.4; 95% CI 1.13–1.72, p< 0.01). As illustrated in Figures 1 and 2, compared to a numerical interpretation, a comprehensive assessment of FFRCT increased the ratio of revascularization per ICA (61.8 vs 50.2%, p < 0.01) and is more accurate to rule-in OCAD patient requiring a myocardial revascularization.