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Introduction: Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is an angiographic-derived index to determine the fractional flow reserve (FFR) in patients with stable coronary artery disease (CAD), without the need of invasive pressure wire and hyperaemic stimulus in FFR. Although the safety of FFR-guided deferral of revascularization in non-ischemic lesions is well-established, clinical events still occur. The aim of the study is to investigate the prognostic implications of caFFR in those without significant ischemia. Methods: 513 stable CAD patients (mean age=64.3±11.1, 57.7% male) with all lesions being nonischemic, defined by caFFR>0.75, without undergoing revascularization were recruited. The study population was divided into high (n=240) and low (n=273) caFFR groups, according to the median value of caFFR (0.89). The primary endpoint was 3-year major adverse cardiac events (MACE), defined as a composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR) and hospitalization for heart failure. Results: A total of 44 composite events occurred, including 17 all-cause mortality, 2 MI, 8 TVR and 17 hospitalization for heart failure. Following multivariate adjustment, patients in low caFFR group had a significantly higher risk of MACE than those in high caFFR group (adjusted hazard ratio [HR], 3.02; 95% confidence interval [Cl], 1.19-7.71; P=0.02). Every 0.01 decrease in caFFR was associated with a higher risk of MACE (adjusted HR, 1.12; 95%Cl, 1.03-1.21; P Conclusions: In stable CAD patients without significant functional ischemia, caFFR provides valuable prognostic information on adverse cardiac outcomes. This novel index could enhance risk stratification in stable CAD patients with nonischemic lesions.

Introduction: Computational pressure-flow dynamics derived fractional flow reserve (caFFR) has emerged for non-invasive assessment of fractional flow reserve (FFR) in patients with stable coronary artery disease (CAD), without the need for hyperaemic induction and guidewire placement in conventional FFR. The clinical value of caFFR in diabetic patients, who are at risk of microvascular dysfunction, has not been validated. The aim of the study is to evaluate the use of caFFR in diabetic patients with stable CAD. Methods: A total of 212 stable CAD patients with diabetes (mean age=67.6±10.6, 66.5% male) were included. Patients were said to be adherent to caFFR if all ischemic vessels, defined by caFFR≤0.8 were treated with PCI and all nonischemic vessels, defined by caFFR>0.8 were not. Otherwise, they were considered to be non-adherent to caFFR. The primary endpoint was 3-year major adverse cardiac events (MACE), defined as a composite of cardiovascular mortality, non-fatal myocardial infarction (MI), stroke and unplanned revascularization. Results: Among the 212 patients, PCI was performed in 62.3% of them. A total of 26 composite events occurred, including 5 cardiovascular mortality, 5 non-fatal MI, 2 strokes and 14 unplanned revascularization. The incidence rate of MACE was significantly lower in adherent patients than in non-adherent patients (5.4% vs 15.8%; P=0.01). After multivariate adjustment, adherent patients had a significantly lower risk of MACE than non-adherent patients (adjusted hazard ratio [HR], 0.33; 95% confidence interval [Cl], 0.13-0.83; P=0.02). Conclusions: In stable CAD patients with diabetes, caFFR-guided revascularization significantly reduces the risk of MACE in 3 years. The findings support the potential use of caFFR in treatment guidance of diabetic patients.