Coronary artery bypass grafting based on computed tomography-derived fractional flow reserve versus angiography: Early results

Min-Seok Kim; Ah-Jin Ryu; Jung Won Kim; Cheol Ho Lee; Seong Wook Hwang; Ki-Bong Kim

doi:10.1016/j.athoracsur.2026.06.024

Coronary artery bypass grafting based on computed tomography-derived fractional flow reserve versus angiography: Early results

Ann Thorac Surg. 2026 Jul 2:S0003-4975(26)00677-6. doi: 10.1016/j.athoracsur.2026.06.024. Online ahead of print.

Authors

Min-Seok Kim¹, Ah-Jin Ryu², Jung Won Kim³, Cheol Ho Lee³, Seong Wook Hwang³, Ki-Bong Kim³

Affiliations

¹ Cardiovascular Center, Myongji Hospital, Gyeonggido, Republic of Korea; Hanyang University College of Medicine, Seoul, Republic of Korea. Electronic address: minseok.kim.md.phd@gmail.com.
² AiMEDiC, Seoul, Republic of Korea.
³ Cardiovascular Center, Myongji Hospital, Gyeonggido, Republic of Korea.

PMID: 42392427
DOI: 10.1016/j.athoracsur.2026.06.024

Abstract

Background: This randomized trial was designed to compare 1-yearoutcomes in patients who received revascularization based on computed tomography-derived fractional flow reserve(CT-FFR) versus quantitative coronary angiography(QCA). In this early analysis, early angiographic and clinical outcomes were compared.

Methods: A total of 106 patients were randomized to undergo coronary artery bypass grafting based on CT-FFR(CT-FFR group,N=53) or QCA(QCA group,N=53). Complete revascularization was achieved for coronary arteries with CT-FFR ≤0.78(CT-FFR group) or those with QCA stenosis(>70% stenosis for left; ≥90% stenosis for right coronary artery territories)(QCA group).. Angiography was performed at median 1[1,1] postoperative day in all patients. Angiographic findings of graft flow were categorized as perfectly patent, competitive(bidirectionally or unidirectionally competitive), or occluded.

Results: There were no differences in patient characteristics between the 2 groups. The average number of revascularized coronary arteries per patient were 3.7±0.8 in the CT-FFR group and 3.5±0.7 in the QCA group(P=0.089). The median difference in expected anastomosis sites was 2[1,3]. There were no operative mortality and no differences in morbidities between the 2 groups. The number of perfectly patent, bidirectionally competitive, and unidirectionally competitive grafts were 167(85.2%),10(5.1%), and 19(9.7%),respectively, in the CT-FFR group(n=196);133(72.7%),23(12.6%), and 27(14.8%),respectively, in the QCA group(n=183). There was a significant difference in the number of perfectly patent grafts between the 2 groups(p=0.007).

Conclusions: The average number of distal anastomoses was similar between the two groups. However, the number of competitive grafts was significantly reduced in the CT-FFR group compared to the QCA group.