First-Line CCT-FFR Lowers Unnecessary Angiography While Boosting Revascularization — Meta-Analysis Supports Functional Imaging Strategy

A new systematic review and meta-analysis published in the Journal of Cardiovascular Computed Tomography (Feb 2025, doi: 10.1016/j.jcct.2025.02.006) evaluates the clinical impact of coronary CT angiography-derived fractional flow reserve (CCT-FFR or FFR CT) in patients with stable coronary artery disease (CAD).

Based on 5 studies (3 RCTs, 2 observational) with 5,282 patients, the analysis compared CCT-FFR as a first-line diagnostic approach against standard non-urgent testing based on clinical judgment.

Key results:

  • Significant reduction in overall ICA rates with CCT-FFR (OR 1.57; p < 0.001)
  • Marked drop in unnecessary ICA without obstructive CAD (OR 6.63; p < 0.001)
  • Higher rate of targeted coronary revascularization in the CCT-FFR group (OR 0.48; p < 0.001)
  • No significant differences in 1-year outcomes: MACE, MI, mortality, or unplanned revascularization

Conclusion:
CCT-FFR as a gatekeeper strategy in stable CAD reduces invasive procedures and enhances appropriate revascularization without compromising clinical outcomes. This supports its use as an effective first-line tool in precision-guided cardiovascular diagnostics.

Read the full article: https://www.sciencedirect.com/science/article/pii/S1934592525000462