Cardiovascular

Prediction of coronary events by computed tomography-derived Murray law-based quantitative flow ratio.

Gim D, Lee S, et al. • EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology • 2026

PubMed 42975599 DOI 10.4244/EIJ-D-26-00575
TL;DR

Both CT-μFR and the CT-μFR gradient are independently associated with 3-year subsequent coronary events, and their combined assessment improves risk stratification beyond CT-μFR alone.

Key Findings

Results

Vessels with CT-μFR ≤0.80 had a markedly higher risk of 3-year subsequent coronary events than vessels with CT-μFR >0.80.

  • Cohort: 885 vessels from 312 patients who underwent invasive coronary angiography for ACS or stable angina and had prior CCTA 6 months to 3 years earlier.
  • Reported as 79.1% vs 20.4%, adjusted HR 6.87, 95% CI 5.26-8.96; p<0.001.
  • CT-μFR was assessed by an independent core laboratory blinded to clinical data.
Results

Vessels with a CT-μFR gradient ≥0.004/mm had a higher risk of 3-year subsequent coronary events than those with a gradient <0.004/mm.

  • Reported as 72.6% vs 27.4%, adjusted HR 4.08, 95% CI 3.15-5.28; p<0.001.
  • The CT-μFR gradient is the longitudinal pressure gradient across the lesion, intended to capture local haemodynamic abnormalities.
  • Primary outcome was a composite of vessel-specific myocardial infarction or urgent revascularisation for ACS.
Results

Among vessels with CT-μFR >0.80, a CT-μFR gradient ≥0.004/mm was still associated with increased risk of events.

  • Adjusted HR 2.59, 95% CI 1.63-4.11; p<0.001.
  • This suggests the gradient captures risk not identified by vessel-level CT-μFR in vessels classified as non-ischaemic.
Results

Adding the CT-μFR gradient to CT-μFR improved discrimination of subsequent coronary events in the overall cohort.

  • Harrell's C-index increased from 0.700 to 0.755; p<0.001.
  • Discrimination was assessed with Harrell's C-index for predictive models.
Results

Adding the CT-μFR gradient improved discrimination in the subgroup of vessels with CT-μFR >0.80.

  • C-index increased from 0.575 to 0.655; p<0.001.
  • Baseline discrimination of CT-μFR alone in this subgroup was modest (0.575).
Conclusions

CT-μFR and the CT-μFR gradient are independently associated with 3-year vessel-level subsequent coronary events, and combined assessment improves risk stratification.

  • Findings are based on adjusted hazard ratios for both measures.
  • Study registered at ClinicalTrials.gov NCT04794868.

What This Means

This study looked at whether heart artery scans taken earlier (coronary CT angiography) could be analyzed by computer to predict which individual arteries would later cause a heart attack or need urgent treatment. Researchers examined 885 arteries from 312 patients. They used two measures: CT-μFR, which estimates how much blood flow is reduced in the whole vessel, and the CT-μFR gradient, which captures how sharply pressure drops across a specific narrowed spot. Both measures were linked to events over 3 years. Arteries with low CT-μFR or a steep pressure gradient had much higher event rates. Notably, even among arteries that looked normal by CT-μFR alone, a steep pressure gradient identified arteries at higher risk. Combining the two measures predicted events better than CT-μFR alone. This research suggests that looking at local pressure changes across a lesion, in addition to overall vessel flow estimates, may help identify arteries at risk that would otherwise be missed. The patients were people who already underwent invasive angiography, so results may not apply to all patients, and further studies would be needed before changing clinical practice.

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Citation

Gim D, Lee S, Ding D, Wang Z, Shin D, Kim S, et al.. (2026). Prediction of coronary events by computed tomography-derived Murray law-based quantitative flow ratio.. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. https://doi.org/10.4244/EIJ-D-26-00575