Objectives To obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD). Methods We searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as ‘all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint. Results Five studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001). Conclusions The 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

中文翻译：

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冠状动脉计算机断层扫描血管造影衍生血流储备分数的预后价值：系统评价和荟萃分析

目的 为了更有效地评估血流储备分数 CT 测试的预后价值，我们对评估 CT 衍生的 FFR 计算 (FFRCT) (HeartFlow) 分析在稳定患者中的临床结果的研究进行了系统的文献回顾和协作荟萃分析。冠状动脉疾病（CAD）。方法 我们在 PubMed 和 Web of Science 电子数据库中搜索已发表的研究，这些研究评估了 2010 年 1 月 1 日至 2020 年 12 月 31 日期间血流储备 CT 检测后的临床结果。主要终点定义为“全因死亡率 (ACM) 或心肌梗死 (MI )' 在 12 个月的随访中。使用主要不良心血管事件（MACE、ACM+MI+计划外血运重建）、ACM、MI、自发性 MI 或计划外（> 3个月）血运重建作为终点。结果 确定了五项研究，包括总共 5460 名符合荟萃分析条件的患者。主要终点发生在 60 名 (1.1%) 患者中，0.6% (13/2126) FFRCT>0.80% 和 1.4% (47/3334) FFRCT ≤0.80（相对风险 (RR) 2.31 (95% CI 1.29 至 4.13) ), p = 0.005)。同样，与 FFRCT >0.80 的患者相比，FFRCT ≤0.80 的患者发生 MACE、MI、自发性 MI 或计划外血运重建的频率更高。每减少 0.10 个单位的 FFRCT 与主要终点的更大风险相关（RR 1.67（95% CI 1.47 至 1.87），p<0.001）。结论 稳定型 CAD 患者的 12 个月结果显示 FFRCT 结果为阴性的患者的事件发生率较低，与检测结果呈阳性的患者相比，检测结果呈阴性的患者出现不良结果的风险更低。此外，FFRCT 数值与结果呈负相关。