Abstract Body (Do not enter title and authors here): Background
Computed tomography-derived fractional flow reserve (CT-FFR) is an emerging analytical tool that
enables noninvasive physiological evaluation and risk stratification of patients with coronary artery
disease (CAD) and correlates closely with invasive FFR. However, data regarding the long-term
prognosis of patients with CAD and negative CT-FFR (>80) are still limited.
Research Questions
Can a CT-FFR >80 predict the long-term event-free survival in patients diagnosed with stable CAD?
Methods
In this systematic review and meta-analysis, a thorough search was conducted in PubMed, Embase, Web
of Science, and Scopus to identify studies that compare clinical outcomes between patients diagnosed
with CAD with CT-FFR >80 or ≤80 regarding major adverse cardiac events (MACE) published until (!).
Time and survival probabilities were extracted from Kaplan-Meier curves for each group. Individual
patient data were reconstructed by processing the extracted time points, survival probabilities, and the
number of patients at risk. The aggregated survival curves and Cox proportional hazard model were fitted
to estimate HRs and 95% CIs. The restricted mean survival time (RMST) was also calculated as the area
under the survival curve for each group.
Results
A total of 14 studies comprising 13,912 patients were included in the IPD-reconstructed meta-analysis for
MACE. Over a follow-up period of up to 120 months, patients with CT-FFR ≤0.80 experienced a
markedly higher cumulative incidence of MACE compared to those with CT-FFR >0.80. The 10-year
MACE-free survival rate was 77.1% in the CT-FFR ≤0.80 group versus 91.4% in the CT-FFR >0.80
group. CT-FFR ≤0.80 was associated with a 197% increased risk of MACE (HR: 2.97; 95% CI:
2.54–3.48; p < 0.001). Furthermore, patients with CT-FFR ≤0.80 managed with Optimal Medical Therapy
exhibited a higher cumulative incidence of MACE than those undergoing Invasive coronary angiography,
with 10-year MACE-free survival rates of 57.85% and 86.1%, respectively. However, this difference did
not reach statistical significance (HR: 1.77; 95% CI: 0.91–3.45; p = 0.09). RMST analysis revealed that
Patients with CT-FFR >0.80 had a mean MACE-free survival of 114.3 months (95% CI: 113.4–115.3),
compared to 105.1 months (95% CI: 103.3–106.9) in those with CT-FFR ≤0.80 (p < 0.001).
Conclusion
Patients with stable CAD and CT-FFR > 80 can be safely stratified as low risk for future fatal and non-
fatal cardiac events due to their long-term predicted MACE-free survival.