Coronary disease & ACSCohort study
Prognostic Value of Coronary Computed Tomography Angiography–Derived Fractional Flow Reserve From a Large Nationwide Cohort
- Retrospective cohort study
- multicentre
- 27 sites across England
- nationwide
Authors' conclusion
FFR-CT is associated with the individual outcomes of MI, cardiovascular death, and all-cause death independent of risk factors and stenosis severity, with lower FFR-CT values associated with worse outcomes. Reduced and severely reduced FFR-CT have the strongest association with future cardiovascular events, with a value of 0.67 defining the optimal risk threshold.
Study context
- Population
- Patients with stable CAD receiving coronary CT angiography and clinically indicated FFR-CT analysis (HeartFlow), England, 2017–2020
- Participants
- 7,836 patients
- Exposure
- FFR-CT categories: normal, borderline, reduced, severely reduced
- Outcome
- Individual outcomes of MI, CV mortality, all-cause mortality and revascularization by lowest per-patient stenosis-specific and distal vessel FFR-CT
- Follow-up
- 3-year follow-up
Main finding
As reported in the abstract
Individual outcomes by stenosis-specific FFR-CT (lower FFR-CT categories)
- Stenosis-specific FFR-CT · myocardial infarction (MI); range across FFR-CT categories
- HR 2.08-5.73; P < 0.001
- Stenosis-specific FFR-CT · CV death; range across FFR-CT categories
- HR 1.51-3.40; P < 0.001
- Stenosis-specific FFR-CT · all-cause death; range across FFR-CT categories
- HR 1.01-1.58; P = 0.01
- Stenosis-specific FFR-CT · revascularization; range across FFR-CT categories
- HR 4.79-24.48; P < 0.001
- Stenosis-specific FFR-CT≤0.7 · MI; adjusted for CV risk factors and stenosis severity (CAD-RADS)
- adjusted HR 2.94-3.39; P < 0.001
- Stenosis-specific FFR-CT ≤0.5 · CV death; adjusted
- adjusted HR 2.92; P = 0.02
- Stenosis-specific FFR-CT ≤0.5 · all-cause death; adjusted
- adjusted HR 1.49; P = 0.045
- Stenosis-specific FFR-CT ≤0.8 · revascularization; adjusted
- adjusted HR 3.02-9.42; P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Normal FFR-CT | Borderline | Reduced | Severely reduced |
|---|---|---|---|---|
| MI or CV death with normal stenosis-specific FFR-CT · 3 years | 1.5% | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract |
Discrimination for MI or CV death, FFR-CT added to risk factor and stenosis severity model
- C index
- 0.783
- ∆C index
- 0.012; P<0.001
Optimal FFR-CT cutoff for risk of future CV events
- Optimal cutoff
- 0.67
Distal-vessel FFR-CT
- Stenosis-specific vs distal-vessel discordance
- 36.4%
- Associated with outcomes similar to stenosis-specific FFR-CT
Original publication
Prognostic Value of Coronary Computed Tomography Angiography–Derived Fractional Flow Reserve From a Large Nationwide Cohort. Circulation. Published 22 September 2026. doi:10.1161/circulationaha.126.081264
Summarised from the published abstract; every number is checked against it