CT-Derived Flow Ratio Predicts 5-Year Cardiac Risk as Well as ICA/SPECT — New Results from CORE320

A recent secondary analysis from the CORE320 study, published in Radiology (Dec 2024, doi: 10.1148/radiol.240299), demonstrates that quantitative flow ratio derived from coronary CT angiography (CT-QFR) is a significant independent predictor of major adverse cardiovascular events (MACEs) over 5 years in patients with suspected coronary artery disease (CAD).

Key findings (n=310):

  • CT-QFR was predictive of MACEs (HR = 1.9; P = .04), independent of clinical variables
  • Prognostic performance matched ICA/SPECT in both normal (82% vs 80%) and abnormal (60% vs 57%) subgroups
  • Prior myocardial infarction was a strong predictor (HR = 2.5; P < .001)
  • Prior PCI impaired CT-QFR’s accuracy (AUC drop from 0.70 to 0.44; P < .001)

Conclusion:
CT-QFR adds functional prognostic value to anatomic CT data and may support noninvasive, long-term risk stratification in CAD — especially in patients without prior revascularization. Its equivalence to invasive approaches in outcome prediction marks a step forward for streamlined cardiac imaging.

Full article: https://pubs.rsna.org/doi/abs/10.1148/radiol.240299