Coronary Computed Tomography Angiography for Percutaneous Coronary Intervention: Initial United States Experience With FFR CT Based Virtual PCI

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ABSTRACT Background Coronary computed tomography angiography (CCTA) and CCTA‐derived fractional flow reserve (FFR CT ) based virtual percutaneous coronary intervention (PCI) can facilitate pre‐procedural planning but there are limited clinical data. Methods Observational cohort study of consecutive patients undergoing CCTA‐guided PCI with the use of the FFR CT ‐based virtual planner, which conjointly with CCTA enables pre‐procedural planning including guide catheter selection, optimal fluoroscopic angles, stent length based on predicted post‐PCI FFR CT , as well as plaque and calcium characterization. We also assessed the correlation between FFR CT and invasive FFR. Results Between April 2023 and January 2025, CCTA‐guided PCI was performed in 52 patients (40% female, mean age 70 ± 9 years, 23% acute coronary syndrome) and 59 PCIs. The left anterior descending artery was the most common target vessel (51%). The median baseline FFR CT was 0.70 (interquartile range [IQR] 0.62−0.74) and the median calcium score was 590 (IQR 189−1169). Intravascular imaging was used in all cases (83% intravascular ultrasound, 17% optical coherence tomography) for stent sizing and/or post‐PCI stent assessment. Thirteen PCIs (22%) required advanced calcium modification (11 intravascular lithotripsy and 2 atherectomy). Median procedural time was 88 (IQR 70−108) min, fluoroscopy time was 18.4 (13.3−26.4) min, contrast volume was 140 (125−180) mL, and air kerma radiation dose was 1.24 (0.82−1.96) Gy. Technical success was 100%. Median post‐PCI invasive FFR was 0.92 [0.89−0.95]. Pre‐ and post‐PCI invasive FFR correlated well with FFR CT ( R = 0.74; p < 0.001). Conclusion CCTA‐guided PCI with FFR CT based virtual pre‐procedural planning was associated with excellent clinical results, with predicted post‐PCI FFR CT associated with observed post‐PCI invasive FFR.

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