Key result
CCT-FFR as a first strategy in suspected stable CAD was associated with reduced overall rates of invasive coronary angiography (OR 1.57; 95% CI 1.36-1.81; P<0.001) compared to standard testing.
Why the study?
Despite promising results, the clinical implications of CCT-FFR remain debated, prompting an evaluation of the potential benefits of incorporating FFRCT into stable CAD management.
Does CCT-FFR as a first strategy reduce invasive coronary angiography and improve clinical outcomes in patients with suspected stable CAD?
Meta-Analysis (n=5,282)
Does CCT-FFR as a first strategy reduce invasive coronary angiography and improve clinical outcomes in patients with suspected stable CAD?
Using CCT-FFR as a first-line strategy in suspected stable CAD reduces unnecessary invasive angiography but increases revascularization rates without altering 1-year clinical outcomes.
Supports CCT-FFR first-line to reduce unnecessary ICA in stable CAD; reinforces neutral 1-year MACE despite increased revascularization.
AIMS: Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management. METHODS: After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 % confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance. RESULTS: 5 studies (3 RCTs and 2 observational studies) globally encompassing 5282 patients (CCT-FFR = 2604 patients, Control Group = 2678 patients) were included in the quantitative analysis. The rates of ICA overall (OR 1.57, 95%CI 1.36-1.81, p value < 0.001) and those without obstructive CAD (OR 6.63, 95%CI 4.79-9.16, p value < 0.001) were reduced in the CCTAFFR group, as compared to the control group. Moreover, CCT-FFR patients underwent coronary revascularization more frequently than patients in the control arm (OR 0.48,CI 0.38-0.62, p value < 0.001). There was no significance difference between the two strategies in terms of 1 year MACE (OR 1.11,CI 0.86-1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41-1.33, p value 0.31), all-cause mortality (OR 1.29,CI 0.47-3.54, p value 0.63) and unplanned revascularization for angina (OR 0.99, 95%CI 0.65-1.49, p value 0.95). CONCLUSIONS: In conclusion, in the management of stable CAD, the use of CCT-FFR was associated with lower overall rates of ICA but higher rates of coronary revascularization with comparable 1-year clinical impact.
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Improta et al. (2025) conducted a meta-analysis in symptomatic stable coronary artery disease (n=5,282). CCT-FFR vs. non-urgent cardiovascular testing was evaluated on overall rates of invasive coronary angiography (ICA) (OR 1.57, 95% CI 1.36-1.81, p=< 0.001). CCT-FFR as a first strategy in suspected stable CAD was associated with reduced overall rates of invasive coronary angiography (OR 1.57; 95% CI 1.36-1.81; P<0.001) compared to standard testing.
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