Evaluation of the ability of CTFFR to determine non-significant lesions of coronary disease based on MACE in one-year follow-up of patients (seeing beyond the stenosis: CTFFR and MACE in a one-year follow-up)

Accurate identification of functionally non-significant coronary lesions is crucial to optimize patient management and avoid unnecessary interventions in coronary artery disease (CAD). Computed tomography-derived fractional flow reserve (CTFFR) has emerged as a non-invasive tool for functional assessment, but its prognostic value for major adverse cardiovascular events (MACE) remains under investigation. This study aimed to evaluate the performance of CTFFR in identifying non-significant coronary lesions and its correlation with the incidence of MACE during a one-year follow-up. In this prospective cohort study, 575 patients with suspected or known CAD and at least one intermediate coronary lesion (50–70% stenosis) underwent coronary computed tomography angiography (CCTA) with CTFFR assessment. Patients were followed for one year to monitor for MACE, defined as cardiac death, acute coronary syndrome (ACS), unplanned revascularization, or hospitalization due to cardiac causes. The mean age of participants was 61.4 ± 11.9 years, and 54.4% were male. During one-year follow-up, 5.6% of patients experienced MACE. Patients with MACE had significantly lower NiFFR values than those without events (0.70 ± 0.10 vs. 0.78 ± 0.13; p < 0.001). Receiver operating characteristic analysis demonstrated moderate discriminatory power for predicting MACE (AUC = 0.699; 95% CI: 0.623–0.769), with sensitivity = 90.6%, specificity = 52.9%, and a notably high negative predictive value = 99.0% at a cut-off of NiFFR = 0.80. CTFFR was linked to one-year major adverse cardiovascular events in patients with intermediate coronary lesions. While its predictive accuracy was moderate (AUC = 0.699), the high NPV supports its use as a non-invasive tool to rule out low-risk patients and guide further evaluation. .(clinicaltrials.org registration : NCT06979427/ 16.05.2025).