Virtual Stenting Based on Fractional Flow Reserve Derived from Computed Tomography in Predicting Post-Percutaneous Coronary Intervention Functional Outcomes: A Retrospective Cohort Study

With the advancement of fractional flow reserve (FFR) derived from computed tomography (FFR_CT), virtual stenting technology has gradually developed. This study investigated the performance of virtual stenting based on FFR_CT in predicting post-percutaneous coronary intervention (PCI) FFR. Data from 75 patients (78 blood vessels) was collected retrospectively. We randomly allocated the participants to discovery (<i>n</i> = 26) and validation (<i>n</i> = 52) cohorts. The FFR_CT was calculated using pre-PCI coronary computed tomography angiography images. Virtual stent implantation was simulated using blinded and non-blinded virtual stenting methods to obtain post-virtual stenting FFR_CT. The median FFR_CT before PCI and invasive FFR were 0.70 (0.60-0.77) and 0.69 (0.63-0.76), respectively. The median FFR_CT were 0.91 (0.86-0.95) and 0.91 (0.87-0.94) in the blinded and non-blinded groups, respectively; the invasive post-PCI FFR was 0.90 (0.88-0.93). The difference between the FFR_CT after using the blinded/non-blinded method and the invasive post-PCI FFR were 0.010 (95% limits of agreement: -0.064 to 0.084) and 0.009 (-0.050 to 0.068) in the discovery cohort and -0.005 (-0.075 to 0.064) and -0.0002 (-0.064 to 0.064) in the validation cohort, respectively. Virtual stenting technology based on FFR_CT can effectively predict functional outcomes after PCI and could be a reliable tool for PCI procedural planning.