Evaluation of CT-FFR for predicting myocardial ischaemia in patients with type A aortic dissection

AIMS: To evaluate the predictive value of CT-FFR for pre-operative myocardial ischaemia in patients with type A aortic dissection. METHODS AND RESULTS: This retrospective study included consecutive TAAD patients who underwent coronary computed tomography angiography (CCTA) between January 2023 and February 2024. The primary endpoint was 30-day post-operative MACE in surgically treated patients, defined as all-cause death, non-fatal myocardial infarction, or unplanned revascularization. Multivariable logistic regression was used to assess the association between CT-FFR and outcomes and to evaluate the incremental predictive value of CT-FFR beyond CCTA and clinical risk factors. A total of 154 patients were included, of whom 140 underwent surgery and 34 (24.3%) experienced 30-day post-operative MACE. CT-FFR ≤0.80 was independently associated with the primary endpoint (adjusted odds ratio 7.18; 95% confidence interval 2.86-18.07; P < 0.001). The most comprehensive predictive model, combining CT-FFR with CCTA findings and clinical risk factors, demonstrated improved discrimination for 30-day post-operative MACE (area under the curve 0.783) with high sensitivity and a high negative predictive value. CONCLUSION: CT-FFR is significantly associated with post-operative MACE in TAAD patients. As a non-invasive functional assessment tool, CT-FFR may help identify high-risk patients and optimize post-operative management strategies.