Clinical Management Across CAD-RADS Categories in Patients with Intermediate CT-FFR

Q: What are the key findings of this study?

Among patients with intermediate CT-FFR, values of 0.71-0.75 were associated with a significantly higher likelihood of planned revascularization compared to 0.76-0.80 (adjusted OR 2.38).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected coronary artery disease with intermediate CT-FFR (n=973). Intervention: CT-FFR 0.71-0.75 vs. CT-FFR 0.76-0.80. Primary outcome: Planned revascularization within 90 days (OR 2.38, 95% CI 1.72-3.29, p=<0.001).

Q: What does this research mean for the field?

In patients with intermediate CT-FFR (0.71-0.80), lower CT-FFR values (0.71-0.75 vs 0.76-0.80) are significantly associated with higher odds of planned revascularization, an association modified by anatomical CAD-RADS category. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate whether CAD-RADS anatomic stenosis severity modifies the association between intermediate CT-FFR (0.71–0.80) and downstream planned revascularization within 90 days.

Yan Chen; Wenjing Jia; Xiaoyu Ma; Yifeng Gao; Zhen Zhou; Lei Xu

doi:10.3390/jcdd13090465

September 15, 2026Journal of Cardiovascular Development and DiseaseOpen Access

Clinical Management Across CAD-RADS Categories in Patients with Intermediate CT-FFR

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Key result

CT-FFR 0.71-0.75 is linked to ~2.4-fold higher odds of planned revascularization versus 0.76-0.80.

OR 2.38
95% CI 1.72-3.29
P<0.001
n=973

Figures

Why the study?

Does lower intermediate CT-FFR (0.71-0.75) increase planned revascularization compared to higher intermediate CT-FFR (0.76-0.80) in symptomatic patients with suspected CAD and intermediate stenosis?

Key Points

To evaluate whether CAD-RADS anatomic stenosis severity modifies the association between intermediate CT-FFR (0.71–0.80) and downstream planned revascularization within 90 days.
Retrospective analysis of 973 symptomatic patients undergoing coronary computed tomography angiography with intermediate index-vessel CT-FFR values between 0.71 and 0.80.
Patients were stratified by index-vessel CAD-RADS category (CAD-RADS 2, 3, or 4) and CT-FFR ranges of 0.71–0.75 (N=304) versus 0.76–0.80 (N=669).
Multivariable logistic regression assessed associations with planned revascularization within 90 days; exploratory MACCE was evaluated over a median follow-up of 384 days.
Planned revascularization occurred in 39.8% (121/304) of patients with CT-FFR 0.71–0.75 versus 19.3% (129/669) with CT-FFR 0.76–0.80 (adjusted OR, 2.38; 95% CI, 1.72–3.29; p < 0.001).
Each 0.01 decrease in CT-FFR was associated with increased odds of revascularization (adjusted OR, 1.23; 95% CI, 1.15–1.32; p < 0.001), with a significant CAD-RADS interaction (p = 0.011) that was strongest in CAD-RADS 3 (adjusted OR, 1.39; 95% CI, 1.25–1.54).

Study Design

Type

Cohort (n=973)

Multicenter

No

Structured PICO

Does lower intermediate CT-FFR (0.71-0.75) increase planned revascularization compared to higher intermediate CT-FFR (0.76-0.80) in symptomatic patients with suspected CAD and intermediate stenosis?

P

Population

973 symptomatic patients with suspected coronary artery disease and intermediate CT-FFR values (0.71-0.80) followed for a median of 384 days.

E

Exposure

Lower intermediate CT-FFR values (0.71-0.75)

C

Comparator

Higher intermediate CT-FFR values (0.76-0.80)

O

Outcome

Planned revascularization within 90 days

Main Result

Odds Ratio: 2.38 (95% CI 1.72–3.29)

Absolute Event Rate: 39.8% vs 19.3%

p-value: p=<0.001

In patients with intermediate CT-FFR values (0.71-0.80), lower values are associated with a higher likelihood of planned revascularization, and this association is most pronounced in patients with CAD-RADS 3 anatomical severity.

Limitations

Retrospective, single-center observational design with potential for residual confounding.
Downstream management was determined by treating physicians without a prespecified protocol.
CCTA and CT-FFR findings were available to physicians, directly informing the management outcome.
Small CAD-RADS 2 subgroup, limiting precision of effect estimates in this category.
Low number of MACCE events (31) limited statistical power for prognostic analyses.
CT-FFR was derived using a single on-site platform.
Retrospective single-center observational study with potential residual confounding
Downstream management was determined by treating physicians with access to CCTA and CT-FFR findings
Lack of detailed information regarding the use of invasive physiological assessment
Small CAD-RADS 2 subgroup limiting precision of effect estimates
Low MACCE event rate limiting statistical power for prognostic analyses
CT-FFR derived using a single on-site platform

Implication

May guide CT-FFR sub-stratification in practice; leaves open outcome benefit and need for prospective validation in CAD-RADS 3.

Abstract

Background: Interpretation of intermediate computed tomography-derived fractional flow reserve (CT-FFR) remains uncertain. We evaluated whether Coronary Artery Disease Reporting and Data System (CAD-RADS) severity modifies the association between CT-FFR and downstream management in patients with CT-FFR 0.71–0.80. Methods: This retrospective study included 973 symptomatic patients stratified by index-vessel CAD-RADS category and CT-FFR 0.71–0.75 versus 0.76–0.80. Planned revascularization within 90 days was the primary outcome. Multivariable logistic regression assessed CT-FFR associations and interaction with CAD-RADS; major adverse cardiac and cerebrovascular events (MACCE) were exploratory. Results: Planned revascularization occurred in 39.8% versus 19.3% of patients with CT-FFR 0.71–0.75 versus 0.76–0.80 (adjusted odds ratio [OR], 2.38; 95% confidence interval [CI], 1.72–3.29; p < 0.001). Each 0.01 decrease in CT-FFR was associated with higher odds of revascularization (adjusted OR, 1.23; 95% CI, 1.15–1.32; p < 0.001). The association differed by CAD-RADS category (interaction p = 0.011), with a more pronounced association observed in CAD-RADS 3 (adjusted OR per 0.01 decrease, 1.39; 95% CI, 1.25–1.54). During a median follow-up of 384 days, 31 patients (3.2%) experienced MACCE, with no significant adjusted association with CT-FFR. Conclusions: Among patients with intermediate CT-FFR, lower values were associated with a higher likelihood of planned revascularization, and the magnitude of this association differed across CAD-RADS categories.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Suspected coronary artery disease with intermediate CT-FFR (n=973). CT-FFR 0.71-0.75 vs. CT-FFR 0.76-0.80 was evaluated on Planned revascularization within 90 days (OR 2.38, 95% CI 1.72-3.29, p=<0.001). Among patients with intermediate CT-FFR, values of 0.71-0.75 were associated with a significantly higher likelihood of planned revascularization compared to 0.76-0.80 (adjusted OR 2.38).

synapsesocial.com/papers/6aabb7c95f706d05830e7242 https://doi.org/10.3390/jcdd13090465

Topics

Coronary artery disease

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Clinical Management Across CAD-RADS Categories in Patients with Intermediate CT-FFR

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Clinical Management Across CAD-RADS Categories in Patients with Intermediate CT-FFR

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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