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_CT) 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_CT-value ≤0.80 represented an abnormal test result. Patients with FFR_CT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFR_CT), all vessels with FFR_CT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFR_CT) ≥1 vessels with FFR_CT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. Results: Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFR_CT ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFR_CT ≤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_CT (n ​= ​135) was similar to patients with FFR_CT >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62–1.40, p ​= ​0.72, while IR-FFR_CT (n ​= ​90) and non-revascularized patients with FFR_CT ≤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_CT provides information regarding risk of recurrent angina.