CT-FFR in stable CAD: A meta-analysis of clinical outcomes and healthcare cost.

In 30 seconds

This meta-analysis compared CT-FFR-guided management with standard care in stable coronary artery disease, including randomised and observational studies. Across nine studies involving 11,371 patients, the randomised trials found fewer invasive coronary angiograms with CT-FFR (20.8% vs 24.9%; OR = 0.71, 95% CI 0.59-0.84). They found no significant difference in revascularization or major adverse cardiac events (MACE). Observational studies suggested lower MACE, but this was not confirmed in trials. Cost findings were heterogeneous and insufficient for firm conclusions.

Key findings

• In randomised trials, invasive coronary angiography occurred in 20.8% vs 24.9% with CT-FFR-guided care (OR = 0.71, 95% CI 0.59-0.84).
• Randomised trials found no significant difference in revascularization (OR = 1.01, 95% CI 0.76-1.34) or MACE (OR = 0.96, 95% CI 0.78-1.18).
• Observational studies associated CT-FFR with lower MACE (OR = 0.43, 95% CI 0.26-0.70), a benefit not confirmed in trials.
• Cost data from four studies were too heterogeneous to pool; reported differences were small and mostly non-significant.

Why it matters

The findings suggest CT-FFR-guided assessment may reduce invasive angiography in stable CAD without a detected increase in revascularization or MACE in randomised evidence. Separating trial from observational results is important: the apparent MACE benefit in cohorts may reflect confounding. Uncertain cost evidence also means economic value cannot be inferred from these results.

What to keep in mind

Cost evidence was heterogeneous and could not be pooled. Certainty was low or very low for outcomes other than ICA and MACE in randomised trials.