Combination of coronary CT angiography, FFR , and risk factors in the prediction of major adverse cardiovascular events in patients suspected CAD.

Background: To examine the utility of fractional flow reserve by coronary computed tomography (CT) angiography (FFR ) for predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD).

Methods: This was a nationwide multicenter prospective cohort study including consecutive 1187 patients aged 50-74 years with suspected CAD and had available coronary CT angiography (CCTA). In patients with ≥50% coronary artery stenosis (CAS), FFR was further analyzed. The Cox proportional hazards model was used to examine the association of FFR and cardiovascular risk factors with incident MACE within 2 years.

Results: Among 933 patients with available information on MACE within 2 years after enrollment, the incidence rate of MACE was higher in 281 patients with CAS than in those without CAS (6.11 vs. 1.16 per 100 patient-year). In 241 patients with CAS, the Cox proportional hazards analysis showed that FFR as well as diabetes mellitus and low high-density lipoprotein cholesterol level were independently associated with incident MACE. Moreover, the hazard ratio was significantly higher in patients harboring all three factors compared to those harboring 0-2 of the three factors (6.01; 95% confidence interval: 2.77-13.03).

Conclusions: Combinatorial assessment using CCTA for stenosis, FFR , and risk factors was useful for more accurate prediction of MACE in patients with suspected CAD. Among patients with CAS, those with lower FFR , diabetes mellitus, and low high-density lipoprotein cholesterol level were at highest risk for MACE during the 2-year period following enrollment.