{
  "abstract": "Background Complete revascularisation has been associated with improved short-term outcomes in patients with coronary artery disease, but whether these benefits persist long-term and can be defined non-invasively remains uncertain. We investigated the long-term prognostic impact of complete versus incomplete revascularisation determined by coronary CT angiography-derived fractional flow reserve (FFR CT).Methods In this prospective multicentre study, 900 patients with new-onset stable angina and at least one coronary stenosis of 30% or greater on coronary CT angiography were followed for a median of 7 years. FFR CT values were obtained for each vessel, and patients were categorised as completely revascularised (all vessels with FFRCT ≤0.80 revascularised), incompletely revascularised (one or more vessels with FFRCT ≤0.80 not revascularised), or with normal physiology (all vessels with FFRCT >0.80). Early revascularisation was defined as treatment within 90 days of the index scan. Quantitative coronary plaque burden was assessed using artificial intelligence-enabled plaque analysis. The primary endpoint was a composite of cardiovascular death or spontaneous myocardial infarction.Results Of 900 patients, 210 (23%) were classified as incompletely revascularised, 167 (19%) as completely revascularised and 523 (58%) as having normal physiology. The primary endpoint occurred in 34 of 210 (16.2%) incompletely revascularised patients, 13 of 167 (7.8%) completely revascularised patients and 30 of 523 (5.7%) with normal physiology. Incomplete revascularisation was associated with higher risk compared with complete revascularisation (HR 2.33, 95% CI 1.23 to 4.42; p=0.01) and normal physiology (HR 3.54, 95% CI 2.16 to 5.81; p<0.001). These associations remained significant after adjustment for total plaque burden, and the risk difference persisted beyond 3 years of follow-up.Conclusion Complete revascularisation defined by CT-derived fractional flow reserve was associated with a sustained reduction in cardiovascular death and spontaneous myocardial infarction over 7 years, supporting its potential role as a non-invasive tool to guide revascularisation strategies in stable coronary artery disease.",
  "authors": [
    {
      "affiliations": [
        "Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark"
      ],
      "name": "Kristian Taekker Madsen"
    },
    {
      "affiliations": [
        "Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Bjarne Linde Nørgaard"
    },
    {
      "affiliations": [
        "Cardiology, Odense University Hospital, Odense, Denmark"
      ],
      "name": "Kristian Altern Øvrehus"
    },
    {
      "affiliations": [
        "Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Jesper Møller Jensen"
    },
    {
      "affiliations": [
        "Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark"
      ],
      "name": "Søren Thorup Scheuer"
    },
    {
      "affiliations": [
        "Department Public Health, Aarhus University, Aarhus, Denmark"
      ],
      "name": "Erik Parner"
    },
    {
      "affiliations": [
        "Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Erik Lerkevang Grove"
    },
    {
      "affiliations": [
        "Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Nadia Iraqi"
    },
    {
      "affiliations": [
        "Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK"
      ],
      "name": "Timothy Fairbairn"
    },
    {
      "affiliations": [
        "Stanford University School of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "Koen Nieman"
    },
    {
      "affiliations": [
        "Medicine, Duke University, Durham, North Carolina, USA"
      ],
      "name": "Manesh R Patel"
    },
    {
      "affiliations": [
        "HeartFlow Inc, Redwood City, California, USA"
      ],
      "name": "Campbell Rogers"
    },
    {
      "affiliations": [
        "HeartFlow Inc, Redwood City, California, USA"
      ],
      "name": "Sarah Mullen"
    },
    {
      "affiliations": [
        "Cardiology, Odense University Hospital, Odense, Denmark"
      ],
      "name": "Hans Mickley"
    },
    {
      "affiliations": [
        "Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark"
      ],
      "name": "Allan Rohold"
    },
    {
      "affiliations": [
        "Cardiology, Aarhus University Hospital, Aarhus, Denmark"
      ],
      "name": "Hans Erik Bøtker"
    },
    {
      "affiliations": [
        "Radiology, St Paul’s Hospital, Vancouver, British Columbia, Canada"
      ],
      "name": "Jonathon A Leipsic"
    },
    {
      "affiliations": [
        "Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark",
        "Regional Health Research, University of Southern Demark, Esbjerg, Denmark"
      ],
      "name": "Niels Peter Rønnow Sand"
    }
  ],
  "title": "Long-term prognostic impact of complete revascularisation defined by CT-derived fractional flow reserve",
  "uid": "365eb033-64f8-573c-8141-0cf61a509819"
}