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

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.