Heart (British Cardiac Society) · 2026
Long-term prognostic impact of complete revascularisation defined by CT-derived fractional flow reserve.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Madsen Kristian Taekker, Nørgaard Bjarne Linde, Øvrehus Kristian Altern, Jensen Jesper Møller, Scheuer Søren Thorup, Parner Erik, Grove Erik Lerkevang, Iraqi Nadia, Fairbairn Timothy, Nieman Koen, Patel Manesh R, Rogers Campbell, Mullen Sarah, Mickley Hans, Rohold Allan, Bøtker Hans Erik, Leipsic Jonathon A, Sand Niels Peter Rønnow
Аннотация
BACKGROUND: Complete revascularisation has been associated with improved short-term outcomes in patients with coronary artery disease, but whether these benefits persist long-term and can be defined non-invasively remains uncertain. We investigated the long-term prognostic impact of complete versus incomplete revascularisation determined by coronary CT angiography-derived fractional flow reserve (FFRCT).
METHODS: In this prospective multicentre study, 900 patients with new-onset stable angina and at least one coronary stenosis of 30% or greater on coronary CT angiography were followed for a median of 7 years. FFRCT values were obtained for each vessel, and patients were categorised as completely revascularised (all vessels with FFRCT ≤0.80 revascularised), incompletely revascularised (one or more vessels with FFRCT ≤0.80 not revascularised), or with normal physiology (all vessels with FFRCT >0.80). Early revascularisation was defined as treatment within 90 days of the index scan. Quantitative coronary plaque burden was assessed using artificial intelligence-enabled plaque analysis. The primary endpoint was a composite of cardiovascular death or spontaneous myocardial infarction.
RESULTS: Of 900 patients, 210 (23%) were classified as incompletely revascularised, 167 (19%) as completely revascularised and 523 (58%) as having normal physiology. The primary endpoint occurred in 34 of 210 (16.2%) incompletely revascularised patients, 13 of 167 (7.8%) completely revascularised patients and 30 of 523 (5.7%) with normal physiology. Incomplete revascularisation was associated with higher risk compared with complete revascularisation (HR 2.33, 95% CI 1.23 to 4.42; p=0.01) and normal physiology (HR 3.54, 95% CI 2.16 to 5.81; p<0.001). These associations remained significant after adjustment for total plaque burden, and the risk difference persisted beyond 3 years of follow-up.
CONCLUSION: Complete revascularisation defined by CT-derived fractional flow reserve was associated with a sustained reduction in cardiovascular death and spontaneous myocardial infarction over 7 years, supporting its potential role as a non-invasive tool to guide revascularisation strategies in stable coronary artery disease.
METHODS: In this prospective multicentre study, 900 patients with new-onset stable angina and at least one coronary stenosis of 30% or greater on coronary CT angiography were followed for a median of 7 years. FFRCT values were obtained for each vessel, and patients were categorised as completely revascularised (all vessels with FFRCT ≤0.80 revascularised), incompletely revascularised (one or more vessels with FFRCT ≤0.80 not revascularised), or with normal physiology (all vessels with FFRCT >0.80). Early revascularisation was defined as treatment within 90 days of the index scan. Quantitative coronary plaque burden was assessed using artificial intelligence-enabled plaque analysis. The primary endpoint was a composite of cardiovascular death or spontaneous myocardial infarction.
RESULTS: Of 900 patients, 210 (23%) were classified as incompletely revascularised, 167 (19%) as completely revascularised and 523 (58%) as having normal physiology. The primary endpoint occurred in 34 of 210 (16.2%) incompletely revascularised patients, 13 of 167 (7.8%) completely revascularised patients and 30 of 523 (5.7%) with normal physiology. Incomplete revascularisation was associated with higher risk compared with complete revascularisation (HR 2.33, 95% CI 1.23 to 4.42; p=0.01) and normal physiology (HR 3.54, 95% CI 2.16 to 5.81; p<0.001). These associations remained significant after adjustment for total plaque burden, and the risk difference persisted beyond 3 years of follow-up.
CONCLUSION: Complete revascularisation defined by CT-derived fractional flow reserve was associated with a sustained reduction in cardiovascular death and spontaneous myocardial infarction over 7 years, supporting its potential role as a non-invasive tool to guide revascularisation strategies in stable coronary artery disease.