Utility of Fractional Flow Reserve Computed Tomography Angiography in Patients With Stable Coronary Artery Disease

Coronary computed tomography angiography is a modality with high negative predictive value for evaluation of coronary artery disease (CAD). However, its diagnostic accuracy for obstructive CAD is limited by multiple factors. Fractional flow reserve (FFR) computed tomography (FFR_CT) is an emerging analysis tool for identifying flow-limiting disease; nonetheless, the prognostic value of FFR_CT is not well established. This meta-analysis aims to evaluate the association of FFR_CT with clinical outcomes in patients with stable CAD. A literature search was conducted for studies reporting the association between FFR_CT measurements and all-cause mortality, major adverse cardiovascular events (MACEs), acute myocardial infarction (AMI), and any need for coronary revascularization. Obstructive disease was defined as a FFR value ≤0.80; nonobstructive disease was defined as an FFR value >0.80. Ten studies were identified to meet the inclusion criteria; mean follow-up was 17 months (range, 3 to 56 months). There was no difference in risk of all-cause mortality between patients with obstructive and those with nonobstructive CAD on FFR_CT. However, obstructive lesions were associated with increased risk of MACE, AMI, and any need for revascularization. FFR_CT is a useful adjunctive modality for further risk stratification of patients with stable CAD. Obstructive lesions identified by FFR_CT are associated with increased risk of MACE, AMI, and any need for revascularization.