Coronary CT angiography-derived fractional flow reserve in-stable angina: association with recurrent chest pain( )

AIMS: The aim of this study was to evaluate the association between coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR(CT)) and recurrent chest pain (CP) at 1-year follow-up in patients with stable angina pectoris (SAP). METHODS AND RESULTS: Study of patients (n = 267) with SAP who underwent CCTA and FFR(CT) testing; 236 (88%) underwent invasive coronary angiography; and 87 (33%) were revascularized. Symptomatic status at 1-year follow-up was gathered by a structured interview. Three different FFR(CT) algorithms were applied using the following criteria for abnormality: (i) 2 cm-FFR(CT) ≤0.80; (ii) d-FFR(CT) ≤0.80; and (iii) a combination in which both a d-FFR(CT) ≤0.80 and a ΔFFR(CT) ≥0.06 must be present in the same vessel (c-FFR(CT)). Patients were classified into two groups based on the FFR(CT) test result and revascularization: completely revascularized/normal (CRN), patients in whom all coronary arteries with an abnormal FFR(CT) test result were revascularized or patients with completely normal FFR(CT) test results, and incompletely revascularized (IR), patients in whom ≥1 coronary artery with an abnormal FFR(CT) test result was not revascularized. Recurrent CP was present in 62 (23%) patients. Classification of patients (CRN or IR) was significantly associated with recurrent CP for all applied FFR(CT) interpretation algorithms. When applying the c-FFR(CT) algorithm, the association with recurrent CP was found, irrespective of the extent of coronary calcification and the degree of coronary stenosis. A negative association between per-patient minimal d-FFR(CT) and recurrent CP was demonstrated, P < 0.005. CONCLUSION: An abnormal FFR(CT) test result is associated with an increased risk of recurrent CP in patients with new-onset SAP.