Clinical value and cost effectiveness of FFR-CT in guiding revascularization and predicting major adverse cardiac events: A meta-analysis

Purpose To assess the clinical value of FFR-CT (Computed Tomography Fractional Flow Reserve) in guiding revascularization, predicting major adverse cardiac events (MACE), and conducting a cost-effectiveness analysis in patients with low-to-moderate risk coronary artery disease. Methods We identified 15 studies evaluating FFR-CT in patients with suspected or known coronary artery disease. Primary outcomes included revascularization rates and MACE occurrence, categorized into FFR-CT negative (FFR-CT > 0.8) and positive (FFR-CT ≤ 0.8) groups. A systematic review of the cost of FFR-CT was also performed. Results In 13,224 patients from 11 studies, the revascularization rate was significantly lower in the FFR-CT negative group (5.8 %) than the positive group (41.4 %) (OR 13.02, 95 % CI 7.08–23.94, p < 0.0001). Unplanned revascularization rates were not significantly different (p = 0.09). In 11,814 patients from seven studies, MACE events were lower in the FFR-CT negative group (0.9 %) than the positive group (2.6 %) (OR 3.62, 95 % CI 1.87–6.97, p = 0.0001). Cost analysis, based on 10 studies, suggested potential savings, though results were heterogeneous due to healthcare cost disparities and lack of long-term follow-up. Conclusion FFR-CT can predict MACE and revascularization needs, potentially improving outcomes and reducing costs. However, it was not effective in guiding unplanned revascularization, and further research is needed to confirm these findings in larger trials.