Virtual Stenting Based on Fractional Flow Reserve Derived from Computed Tomography in Predicting Post-Percutaneous Coronary Intervention Functional Outcomes: A Retrospective Cohort Study

With the advancement of fractional flow reserve (FFR) derived from computed tomography (FFRCT), virtual stenting technology has gradually developed. This study investigated the performance of virtual stenting based on FFRCT in predicting post-percutaneous coronary intervention (PCI) FFR. Data from 75 patients (78 blood vessels) was collected retrospectively. We randomly allocated the participants to discovery (n = 26) and validation (n = 52) cohorts. The FFRCT was calculated using pre-PCI coronary computed tomography angiography images. Virtual stent implantation was simulated using blinded and non-blinded virtual stenting methods to obtain post-virtual stenting FFRCT. The median FFRCT before PCI and invasive FFR were 0.70 (0.60–0.77) and 0.69 (0.63–0.76), respectively. The median FFRCT were 0.91 (0.86–0.95) and 0.91 (0.87–0.94) in the blinded and non-blinded groups, respectively; the invasive post-PCI FFR was 0.90 (0.88–0.93). The difference between the FFRCT after using the blinded/non-blinded method and the invasive post-PCI FFR were 0.010 (95% limits of agreement: −0.064 to 0.084) and 0.009 (−0.050 to 0.068) in the discovery cohort and −0.005 (−0.075 to 0.064) and −0.0002 (−0.064 to 0.064) in the validation cohort, respectively. Virtual stenting technology based on FFRCT can effectively predict functional outcomes after PCI and could be a reliable tool for PCI procedural planning.