Clinical Outcomes of Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve.

Abstract

Coronary computed tomography angiography-derived fractional flow reserve (FFR_CT) is useful for noninvasively detecting coronary artery disease. This procedure has been covered by health insurance reimbursement in the United Kingdom, the United States of America, and Japan. This is the first study to investigate the 1-year outcomes of the FFR_CT, with management covered by health insurance from the DiscoverY of Novel Assessment Myocardial IsChemia by FFR_CT (DYNAMIC-FFR_CT) registry.In this multicenter DYNAMIC-FFR_CT registry, 410 participants who underwent FFR_CT analysis under health insurance reimbursement were prospectively enrolled at six Japanese sites between October 2019 and November 2021. In accordance with recent guidelines, all participants received appropriate revascularization and/or optimal medication therapy after FFR_CT. The following clinical outcomes through the 1-year defined major adverse cardiovascular event (MACE) were investigated: all-cause death, cardiovascular events including non-fatal myocardial infarction, and unplanned hospitalization for acute coronary syndrome leading to revascularization.Of the six MACE cases, four (1.6%) occurred in participants with an FFR_CT value ≤ 0.80, whereas two (1.3%) occurred in a participant with an FFR_CT value > 0.80.This analytical study based on the DYNAMIC-FFR_CT registry for cardiovascular conditions found no significant difference in 1-year MACE between FFR_CT≤ 0.80 and > 0.80 following guideline-based therapy. The registry was started shortly after reimbursement and had limited statistical power and selection bias. Further studies with sufficient statistical power are required.