Effect of CT-FFR on treatment decisions and clinical prognosis in patients with in-stent restenosis

Li Zhiwen; Ru Leisheng; Gong Hongxi; Qi Shuying; Ma Yanzhuo; Wu Bianwen; Yang Qian

doi:10.3969/j.issn.1674-4055.2025.07.06

Abstract：Objective To investigate the impact of treatment decisions based on coronary computed tomography angiography-derived fractional flow reserve(CT-FFR)and clinical prognosis in patients with in-stent restenosis(ISR).Methods A total of 156 ISR patients who underwent re-intervention at from January 1,2022 to December 31,2022 were enrolled.According to the results of 1∶1 propensity score matching,they were divided into the CT-FFR group(n=78)and the coronary angiography(CAG)group(n=78).Patients with FFR ≤0.8(in the CT-FFR group)or ISR ≥70％(in the CAG group)received percutaneous coronary intervention(PCI),and were included in the CT-FFR+PCI(n=34)and CAG+PCI(n=26)groups,respectively.Patients with FFR＞0.8(CT-FFR group)or ISR＜70％(CAG group)received optimal medical treatment(OMT),and were included in the CT-FFR+OMT(n=44)and CAG+OMT(n=52)groups.The diagnostic agreement between CT-FFR and CAG was assessed using the kappa test.Kaplan-Meier survival curves,stratified log-rank tests,and Cox proportional hazards models were applied to evaluate the impact of CT-FFR-guided treatment decisions on the incidence of major adverse cardiovascular events(MACE).Results The positive concordance rate between CT-FFR and CAG was 88.57％,the negative concordance rate of negative lesions was 93.02％,and the overall diagnostic concordance rate was 91.03％(Kappa=0.818,P＜0.001),indicating good agreement.During the median follow-up time of 355.0 days(range 2～432 days),40 patients(25.64％)developed MACE,and the number of patients with MACE in CT-FFR+PCI group,CT-FFR+OMT group,CAG+PCI group,and CAG+OMT group were 7 cases(20.59％),6 cases(13.64％),7 cases(26.92％),and 20 cases(38.46％),respectively,and there was no significant difference in survival time between the groups(P=0.070).The incidence of MACE in the CT-FFR group was slightly lower than that in the CAG group(13 vs.20 cases,Log-Rank=5.350,P=0.021).The incidence of MACE in the CT-FFR+OMT group was slightly lower than that in the CAG+OMT group(Log-Rank=6.451,P=0.011).There was no significant difference in the incidence of MACE between the CT-FFR+PCI group and the CAG+PCI group(P=0.753).After correcting for several clinical factors in the Cox model,the use of CT-FFR to guide treatment decisions was found to reduce the risk of MACE after ISR(P＜0.05).Conclusion CT-FFR is feasible for guiding treatment strategies in ISR patients,shows good diagnostic concordance with traditional CAG and does not increase the incidence of MACE.