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

Aims: 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. Methods: 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. Results: 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). Conclusions: 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.