Utility of the sum of CT-derived fractional flow reserve in three coronary arteries for predicting long-term prognosis in patients with newly diagnosed unstable angina

Objective: To evaluate the utility of the sum of computed tomography-derived fractional flow reserve in three coronary arteries (3v-CT-FFR) for predicting major adverse cardiac and cerebrovascular events (MACCEs) in patients with newly diagnosed unstable angina (UA). Methods: This retrospective study included 157 consecutive patients who were diagnosed with UA via coronary CT angiography and concurrent invasive coronary angiography between January 2021 and December 2022 at the First Affiliated Hospital of Bengbu Medical University. The 3v-CT-FFR was defined as the sum of the CT-FFR values for the left anterior descending artery, left circumflex artery, and right coronary artery. The primary endpoint was the occurrence of MACCEs, including all-cause death, cardiac death, nonfatal myocardial infarction, recurrent angina, heart failure, unplanned revascularization, and/or stroke. The optimal cutoff value was determined using receiver operating characteristic curve analysis. Kaplan–Meier survival curves and Cox proportional hazards models were constructed to evaluate the independent utility of the 3v-CT-FFR for predicting MACCEs. Results: A total of 157 patients were included in this study, with a median follow-up duration of 30 months. During follow-up, 43 MACCEs (27.4%) were reported. The optimal 3v-CT-FFR cutoff value for predicting MACCEs was 2.50, with an area under the curve of 0.729 (95% confidence interval [CI]: 0.646–0.812, P < 0.001), a sensitivity of 81.4%, and a specificity of 57.0%. Patients with a 3v-CT-FFR ≤ 2.50 had a significantly greater incidence of MACCEs than did those with a 3v-CT-FFR > 2.50 (38.0% vs. 16.7%, P = 0.003). Multivariate Cox regression analysis revealed that a 3v-CT-FFR ≤ 2.50 was an independent risk factor for MACCEs (hazard ratio: 4.121; 95% CI: 2.108–8.054; P < 0.001). Kaplan–Meier analysis showed that the event-free survival rate was significantly lower in the 3v-CT-FFR ≤ 2.50 group than in the >2.50 group (log-rank P < 0.001). Conclusion: A 3v-CT-FFR value ≤ 2.50 is a significant predictor of mid- to long-term MACCEs in patients with newly diagnosed UA. It holds potential value for clinical risk stratification and may help guide interventional decision-making.