12 Dec EACVI 2025: AI-based tool predicts future cardiovascular events in patients with angina

MedicalResearch.com Interview with:

Prof. Fairbairn

Prof. Timothy Fairbairn MBChB, PhD FRCP

 and

Dr. Bell

Dr.  Jack Bell

Liverpool Heart and Chest Hospital
Liverpool, UK
 

MedicalResearch.com: What is the background for this study?

Response: Coronary computed tomography angiography (CCTA) is a non-invasive heart scan used in the first-line investigation of patients with suspected stable coronary artery disease (CAD). While CCTA clearly shows blockages in coronary arteries, it is limited in its ability to estimate reduced blood flow, which is necessary to diagnose angina.

An artificial intelligence-based tool (Heartflow) has been developed that analyses CCTA images and provides an estimate of blood flow: CT-derived fractional flow reserve (FFR-CT). The real-world, retrospective English FISH&CHIPS study demonstrated that including FFR-CT as a decision-making tool in the diagnosis of stable CAD reduces the number of subsequent invasive and non-invasive tests performed.

Whether FFR-CT could also be used prognostically, to predict future major cardiovascular events, was not fully understood. Previous studies have had small patient numbers, short follow-up and investigated combined cardiovascular outcomes. We performed an analysis on the national FISH&CHIPS population, which was large enough to determine if FFR-CT adds incremental value to traditional cardiovascular risk factors in predicting cardiovascular outcomes and death.

MedicalResearch.com: What are the main findings?

Response: Of 90,553 patients receiving CCTA, 7,836 patients underwent FFR-CT. They had a median age of 63 years and 37.4% were female. At a median follow up of 3.1 years, there were 191 myocardial infarctions (MIs) (2.4%), 1,573 revascularisations (20.1%), 74 cardiovascular deaths (0.9%) and 261 all-cause deaths (3.3%).

When FFR-CT was measured close to the stenosis (blockage) site, lower values were associated with higher cardiovascular event rates: FFR-CT categories incrementally stratified risk of MI (p<0.001), revascularisation (p<0.001), cardiovascular mortality (p<0.001) and all-cause mortality (p=0.002) over time. Patients with the lowest FFR-CT values had a nearly six-fold increased risk of a heart attack and a three-fold increased risk of dying from a heart attack in the three-years following a CCTA.

This increased risk was independent of traditional cardiovascular risk factors such as age, sex, hypertension, diabetes and high cholesterol. 

MedicalResearch.com: What should readers take away from your report?

Response:  Adding to its diagnostic abilities, this study is the first to provide conclusive evidence of FFR-CT’s prognostic power, independent of other risk factors. We observed that even so-called ‘borderline’ FFR-CT was associated with worse outcomes compared with normal values, but the individuals with the lowest values have the highest risk. FFR-CT could be used to inform personalised risk assessment, allowing us to provide more intensive bespoke treatment to those at high risk. 

Reference:

Bell JS, et al. Prognostic value of coronary computed tomography angiography-derived fractional flow reserve (FFR-CT) from a large nationwide cohort. EACVI 2025, December 2025. 

Funding: The FISH&CHIPS study is funded by the UK Medical Research Council. Heartflow performed the FFR-CT analysis but did not fund the study nor were they involved in the analysis.

Disclosures: Doctor Bell and Professor Fairbairn report no disclosures related to this study.

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Last Updated on December 12, 2025 by Marie Benz MD FAAD