Computed tomography derived FFR and plaque features in prognosis of aortic stenosis combined with coronary artery disease after TAVR

To assess the value of computed tomography angiography (CTA)-derived fractional flow reserve (CT-FFR) and high-risk plaque characteristics (HRPC) in the prediction of prognosis in patients with concomitant aortic stenosis (AS) and coronary artery disease (CAD) after transcatheter aortic valve replacement (TAVR). The study was a post hoc analysis from a multicenter TAVR registry. Patients with AS and obstructive CAD who underwent successful TAVR treatment were enrolled. The CT-FFR and HRPC were measured in coronary vessels with ≥ 50% stenosis lesions. The patients were then grouped according to CT-FFR (≤ 0.8 vs. >0.8) and HRPC (Yes vs. No) criteria. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, nonfatal myocardial infarction, and ischemia-driven revascularization. The multivariable Cox proportional regression was used to identify independent predictors of MACE. To assess the combined prognostic value of CT-FFR and HRPC to OPT-CAD risk, receiver operating characteristic curves were used and the area under the curve (AUC) was determined. A total of 213 patients were enrolled. The mean age was 74.34 years and 125 (58.4%) were male. The patients with lower CT-FFR (≤ 0.8) had a higher rate of MACE compared with those with CT-FFR > 0.8 (11.9% vs. 2.3%, P = 0.011). However, there was no significant difference in MACE incidence (9.0% vs. 5.3%, P = 0.38) between patients with and without HRPC, respectively. The Cox regression model revealed that advanced age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.003-1.15, P = 0.04), elevated NT-proBNP levels (HR 1.004, 95% CI 1.00-1.01, P = 0.046), and higher CT-FFR (HR 0.78, 95% CI 0.62-0.97, P = 0.03) were independent predictors of MACE. The optimal threshold value for predicting MACE using CT-FFR was determined to be 0.79. The performance in predicting MACE using the OPT-CAD score model was enhanced when both CT-FFR and HRPC were incorporated into the model [AUC 0.63 (0.49-0.76) vs. 0.74 (0.63-0.84), P = 0.04]. Pre-procedure CT-FFR was an independent predictor of MACE in patients with concomitant AS and CAD after TAVR.