Key result
Functional FFRCT Score is linked to ~4% higher 9-month MACE risk across both sexes.
Why the study?
Does the Functional FFRCT Score predict major adverse cardiovascular events equally well in men and women with stable symptomatic CAD?
Cohort (n=212)
Does the Functional FFRCT Score predict major adverse cardiovascular events equally well in men and women with stable symptomatic CAD?
Hazard Ratio: 1.04 (95% CI 1.01–1.08)
The Functional FFRCT Score is an independent predictor of adverse events at 9 months in patients with stable symptomatic CAD, performing equally well in both men and women.
Background Observational data suggests there are significant differences between the anatomical coronary artery disease (CAD) severity on coronary computed tomography angiography (CCTA) and the flow impairment estimated via fractional flow reserve derived from computed tomography (FFRCT) between men and women. Purpose We hypothesize that the previously validated Functional FFRCT Score (FFS), combining estimated of atheroma and ischaemia burden, would provide good risk prediction capabilities in both sexes. Methods This is a retrospective analysis, including a cohort of symptomatic stable patients with CAD, who underwent both CCTA and FFRCT, investigating the distribution of the FFS by sex and the discriminatory ability of the FFS for revascularization and major adverse cardiovascular events (MACE), stratified by sex. Univariable and multivariable regression analysis was employed to identify the predictors of MACE. Results This analysis includes 212 participants, of whom 68 (32.1%) were women and 144 (67.9%) were men. The overall median FFS was 9 (IQR 4-15), with a median FFS of 5 (IQR: 4-9) for women and 10 (IQR 9-13) for men, p<0.001. The discriminatory ability of the FFS for MACE was equally good in both sexes with AUCs of 0.75 (95% CI :0.65-0.84) for male patients and 0.75 (95% CI: 0.60-0.90) for female patients, respectively. In multivariable Cox regression analysis including sex, Diamond-Forrester classification, significant CAD, any positive FFRCT (≤0.8) and the FFS, the only independent predictors of MACE were the FFS (HR 1.04, 95% CI: 1.01-1.08) and the presence of any positive FFRCT (HR 4.16, 95% CI: 1.20-14.46), while sex was no longer statistically significant (p 0.34). Conclusions The novel Functional FFRCT Score performs equally well as a risk predictor marker, in both males and females, and is an independent predictor of adverse events by 9-month follow-up in patients with stable symptomatic CAD, whereas sex was no longer statistically significant upon adjustment. Further, prospective validation in larger cohorts is required to determine the impact of an FFS guided management, irrespective of sex.
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Gabara et al. (2025) conducted a cohort in symptomatic stable coronary artery disease (n=212). Functional FFRCT Score (FFS) was evaluated on major adverse cardiovascular events (MACE) (HR 1.04, 95% CI 1.01-1.08). The Functional FFRCT Score was an independent predictor of MACE at 9 months (HR 1.04; 95% CI 1.01-1.08) and demonstrated equally good discriminatory ability in both men and women.
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