AI-Enhanced FFR-CT Shown to Predict Heart Attacks and Death in Patients With Suspected Coronary Disease

AI-Enhanced FFR-CT Shown to Predict Heart Attacks and Death in Patients With Suspected Coronary Disease

(IN BRIEF) A nationwide retrospective study presented at EACVI 2025 found that AI-derived fractional flow reserve from coronary CT (FFR-CT) is a strong independent predictor of future cardiovascular events in patients undergoing evaluation for suspected stable coronary artery disease. Using data from more than 7,800 patients in the FISH&CHIPS cohort, the analysis showed that reduced FFR-CT values were associated with significantly higher rates of myocardial infarction, revascularisation, cardiovascular death and all-cause mortality over a median follow-up of three years. Patients with severely reduced values faced a four-fold increased risk of heart attack and a three-fold increased risk of cardiovascular death, even after accounting for traditional risk factors. Study authors emphasised that FFR-CT may provide a valuable tool for personalised risk assessment in stable CAD, enabling clinicians to identify high-risk individuals who may benefit from more intensive treatment. The results complement earlier evidence showing that FFR-CT reduces the number of unnecessary downstream tests and may also have cost-effectiveness benefits.

(PRESS RELEASE) SOPHIA ANTIPOLIS, 11-Dec-2025 — /EuropaWire/ — A large nationwide analysis presented today at EACVI 2025, the flagship congress of the European Association of Cardiovascular Imaging (EACVI), shows that an artificial intelligence-based imaging tool measuring coronary blood flow can predict future cardiovascular events and mortality in patients undergoing evaluation for suspected stable coronary artery disease (CAD). The findings highlight the potential role of AI-enhanced CT imaging in tailoring risk assessment and treatment decisions for patients with reduced coronary blood flow.

Stable CAD commonly presents as recurrent episodes of chest discomfort or angina. Coronary computed tomography angiography (CCTA) is the standard first-line non-invasive test used to detect blockages in coronary arteries. While CCTA accurately visualises anatomical narrowing, it does not directly measure the physiological impact—namely, reduced blood flow—that contributes to angina symptoms.

To address this, researchers have increasingly turned to CT-derived fractional flow reserve (FFR-CT), an AI-driven technology that analyses CCTA images to estimate blood flow and the functional severity of coronary lesions. Previous studies, including the UK-wide FISH&CHIPS programme, have already shown that using FFR-CT can reduce the need for additional invasive or non-invasive testing in the diagnostic pathway. However, the prognostic value of FFR-CT has remained unclear—until now.

AI-derived blood flow proves strongly predictive of outcomes

Study presenter Doctor Jack Bell of Liverpool Heart and Chest Hospital explained that this new analysis, drawn from a national FISH&CHIPS cohort, was designed to determine whether FFR-CT could independently predict future major cardiovascular events and death, beyond established clinical risk factors.

The analysis included 7,836 patients who underwent FFR-CT among a total CCTA population of 90,553 individuals from 27 centres across England. Patients had a median age of 63 years; 37.4% were women. FFR-CT values were divided into four categories:

• Normal (>0.8)

• Borderline (0.71–0.8)

• Reduced (0.51–0.7)

• Severely reduced (≤0.5)

Over a median follow-up of three years, the cohort experienced:

• 191 myocardial infarctions (2.4%)

• 1,573 revascularisations (20.1%)

• 74 cardiovascular deaths (0.9%)

• 261 all-cause deaths (3.3%)

Lower FFR-CT values were strongly and progressively associated with increased risk of myocardial infarction, revascularisation, cardiovascular death and all-cause mortality. For example, the rate of myocardial infarction rose from 1.0% in patients with normal FFR-CT to 5.2% in those with severely reduced FFR-CT. Patients with the lowest values had a four-fold increased risk of heart attack and a three-fold higher risk of cardiovascular death.

These risks remained significant even after adjusting for age, sex, hypertension, diabetes, dyslipidaemia and other conventional cardiovascular risk factors.

Expert insights and clinical implications

Senior author Professor Timothy Fairbairn, also from Liverpool Heart and Chest Hospital, stated:
“This study is the first to conclusively demonstrate the independent prognostic value of FFR-CT. Even borderline reductions in blood flow were linked with worse outcomes, but the highest-risk group was those with the lowest values. These insights show that FFR-CT may help us personalise risk assessment, enabling more targeted treatment for patients who need it most.”

Additional research evaluating the cost-effectiveness of FFR-CT in stable CAD will also be presented at EACVI 2025.

Notes to editor

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.

References:   

1 ‘Prognostic value of coronary computed tomography angiography-derived fractional flow reserve (FFR-CT) from a large nationwide cohort’ presented during the Advances in Science in Cardiac Computed Tomography session on 11 December at 08:30 to 10:00 CET in Room Agora.

2 Fairbairn TA, Mullen L, Nicol E, et al. Implementation of a national AI technology program on cardiovascular outcomes and the health system. Nat Med. 2025;31:1903–1910.

3 ‘FISH and CHIPs (FFRCT in stable heart disease and coronary computed tomography angiography helps improve patient care and societal costs): cost effectiveness results’ presented during the Advances in Science in Cardiac Computed Tomography session on 11 December at 08:30 to 10:00 CET in Room Agora.

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