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

Kristian Tækker Madsen*, Karsten Tange Veien, Pia Larsen, Majed Husain, Lone Deibjerg, Anders Junker, Martin Weber Kusk, Kristian Korsgaard Thomsen, Allan Rohold, Lisette Okkels Jensen, Niels Peter Rønnow Sand

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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AIMS: The aim of this study was to evaluate the association between coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) 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 FFRCT 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 FFRCT algorithms were applied using the following criteria for abnormality: (i) 2 cm-FFRCT ≤0.80; (ii) d-FFRCT ≤0.80; and (iii) a combination in which both a d-FFRCT ≤0.80 and a ΔFFRCT ≥0.06 must be present in the same vessel (c-FFRCT). Patients were classified into two groups based on the FFRCT test result and revascularization: completely revascularized/normal (CRN), patients in whom all coronary arteries with an abnormal FFRCT test result were revascularized or patients with completely normal FFRCT test results, and incompletely revascularized (IR), patients in whom ≥1 coronary artery with an abnormal FFRCT 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 FFRCT interpretation algorithms. When applying the c-FFRCT 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-FFRCT and recurrent CP was demonstrated, P < 0.005.

CONCLUSION: An abnormal FFRCT test result is associated with an increased risk of recurrent CP in patients with new-onset SAP.

Original languageEnglish
JournalEuropean Heart Journal - Cardiovascular Imaging
Issue number11
Pages (from-to)1511-1519
Publication statusPublished - 20. Oct 2022


  • chest pain
  • coronary computed tomography angiography
  • coronary revascularization
  • stable angina pectoris
  • Severity of Illness Index
  • Predictive Value of Tests
  • Computed Tomography Angiography/methods
  • Humans
  • Coronary Artery Disease/complications
  • Angina, Stable/diagnostic imaging
  • Coronary Vessels
  • Coronary Stenosis/diagnostic imaging
  • Fractional Flow Reserve, Myocardial
  • Coronary Angiography/methods
  • FFR


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