Prognostic value of CT-derived myocardial blood flow, CT fractional flow reserve and high-risk plaque features for predicting major adverse cardiac events.

Background Myocardial blood flow (MBF), CT fractional flow reserve (CT-FFR) and high-risk plaque (HRP) features have been revealed to be associated with patients' prognosis. However, direct intra-individual comparison of these CT-derived parameters has not been explored yet. The aim of this study was to investigate the prognostic value of CT-derived MBF, CT-FFR and HRP features for predicting major adverse cardiac events (MACEs). Methods Consecutive patients with chest pain and intermediate-to-high pre-test probability of coronary artery disease (CAD) were prospectively enrolled. All patients were referred for dynamic CT myocardial perfusion imaging (CT-MPI) + coronary CT angiography (CCTA) and followed up for at least 1 year. MBFischemic (mean MBF of all ischemic segments), MBFratio (MBF of ischemic segments/MBF of reference segments), CT-FFR and HRP features were measured and multivariate analysis was used to evaluate the predictive value of all above parameters for MACEs. Results One hundred and forty-two patients were included into final analysis. MBFischemic and MBFratio was significantly lower in patients with MACE compared to patients without MACE (87 vs. 153 mL/100 mL/min and 0.64 vs. 0.95, both P<0.001). Similarly, CT-FFR was also markedly lower in patients with MACE (0.58 vs. 0.88, P<0.001) whereas coronary artery calcium score (CACS) was significantly higher (1,038.9 vs. 34.2, P<0.001). According to ROC curve analysis, MBFischemic, MBFratio and CACS had largest area under curve (AUC =0.872, 0.855 and 0.813 respectively, all P<0.001) for identifying patients with MACE. After adjusted by multivariate analysis, MBFischemic (hazard ratio =23.382, P=0.003) and CACS (hazard ratio =3.759, P=0.029) were revealed to be the independent predictors for MACE where CT-FFR and HRP features failed to have prognostic value. Conclusions MBFischemic derived from dynamic CT-MPI was the strongest predictor for MACE, followed by CACS. MBFischemic outperformed HRP features and CT-FFR for prediction of unfavorable clinical outcome.