CT-FFR in stable CAD: A meta-analysis of clinical outcomes and healthcare cost
In brief
CT-FFR reduces invasive coronary angiograms by about four percent in stable CAD
In three randomized trials of 11,371 patients, using CT-FFR to guide care lowered the rate of invasive angiography from 24.9% to 20.8% without increasing revascularization or major cardiac events. Observational data suggested fewer events but likely reflect bias, and cost analyses were inconsistent, leaving economic impact unclear.
- Journal
- Clinical imaging (Q2)
- Published
- 9 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Lan Tan, Jie Gong, Xianv Chen, Piao Tan, Xinxin Zou, Jingjian Chen
- PMID
- 42759404
- DOI
- 10.1016/j.clinimag.2026.110952
Why clinicians should know about it
- Picked for Anatomy (top studies of the week, 20 September 2026).
Abstract
BACKGROUND: Computed tomography-derived fractional flow reserve (CT-FFR) integrates anatomical and functional assessment for coronary artery disease (CAD). However, its impact on clinical outcomes and costs remains debated. METHODS: We searched six databases (Jan 2010-Nov 2025) for studies comparing CT-FFR-guided management with standard care in stable CAD, reporting major adverse cardiac events (MACE), revascularization, invasive coronary angiography (ICA), or costs. Odds ratios (ORs) were pooled using random-effects models; randomized and observational evidence was analyzed separately. Costs were synthesized descriptively; certainty was rated using GRADE. RESULTS: Nine studies (11,371 patients; 3 RCTs, 6 cohorts) were included. In RCTs, CT-FFR significantly reduced ICA (20.8% vs 24.9%; OR = 0.71, 95% CI 0.59-0.84) but not revascularization (OR = 1.01, 95% CI 0.76-1.34) or MACE (OR = 0.96, 95% CI 0.78-1.18). Observational studies showed lower MACE with CT-FFR (OR = 0.43, 95% CI 0.26-0.70), not confirmed in trials. Cost data (4 studies) were too heterogeneous to pool; differences were small and mostly non-significant. Certainty was moderate for ICA and MACE (RCTs); low or very low for other outcomes. CONCLUSIONS: CT-FFR-guided care safely reduces ICA without increasing revascularization or MACE in stable CAD. Observational MACE benefits likely reflect confounding. Cost evidence remains insufficient for definitive conclusions; formal economic evaluations are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.