Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study.

Background: The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFR) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain.

Methods: Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 ​% coronary stenosis. A per-patient lowest FFR-value ≤0.80 represented an abnormal test result. Patients with FFR ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFR), all vessels with FFR ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFR) ≥1 vessels with FFR ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire.

Results: Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFR ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFR ≤0.80 vs ​> ​0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 ​% CI: 1.31-2.52, p ​< ​0.001. Risk of recurrent angina in CR-FFR (n ​= ​135) was similar to patients with FFR >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62-1.40, p ​= ​0.72, while IR-FFR (n ​= ​90) and non-revascularized patients with FFR ≤0.80 (n ​= ​285) had increased risk, 37 ​% vs 15 ​% RR: 2.50; 95 ​% CI: 1.68-3.73, p ​< ​0.001 and 30 ​% vs 15 ​%, RR: 2.03; 95 ​% CI: 1.44-2.87, p ​< ​0.001, respectively. Use of antianginal medication was similar across study groups.

Conclusion: In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFR provides information regarding risk of recurrent angina.