Clinical impact of CCT-FFR as first-strategy in patients with symptomatic stable coronary artery disease: A systematic review and meta-analysis.

Abstract

Despite the promising results, the clinical implications of the CCT-FFR is already debated. This metanalysis aimed to determine the potential benefits of incorporating FFRCT into stable CAD management. After searching for studies comparing outcomes of patients with suspected stable CAD who underwent CCT-FFR as a first strategy versus non-urgent cardiovascular testing after a clinical judgment, we calculated odds ratios (ORs) and 95 ​% confidence intervals (CIs) using a random-effects or fixed-effects meta-analysis model depending on heterogeneity significance. 5 studies (3 RCTs and 2 observational studies) globally encompassing 5282 patients (CCT-FFR ​= ​2604 patients, Control Group ​= ​2678 patients) were included in the quantitative analysis. The rates of ICA overall (OR 1.57, 95%CI 1.36-1.81, p value ​< ​0.001) and those without obstructive CAD (OR 6.63, 95%CI 4.79-9.16, p value ​< ​0.001) were reduced in the CCTAFFR group, as compared to the control group. Moreover, CCT-FFR patients underwent coronary revascularization more frequently than patients in the control arm (OR 0.48,CI 0.38-0.62, p value ​< ​0.001). There was no significance difference between the two strategies in terms of 1 year MACE (OR 1.11,CI 0.86-1.44, p value 0.42), nonfatal MI (OR 0.73, CI 0.41-1.33, p value 0.31), all-cause mortality (OR 1.29,CI 0.47-3.54, p value 0.63) and unplanned revascularization for angina (OR 0.99, 95%CI 0.65-1.49, p value 0.95). In conclusion, in the management of stable CAD, the use of CCT-FFR was associated with lower overall rates of ICA but higher rates of coronary revascularization with comparable 1-year clinical impact.