Coronary CT angiography (CCTA) is a valuable tool for excluding coronary artery disease, though its lack of specificity remains a limitation (1-3). To minimize unnecessary invasive catheter angiographies (ICA), current guidelines recommend the use of CT-derived fractional flow reserve (CT-FFR) to assess the hemodynamic significance of coronary artery stenosis (4). Additionally, the introduction of photon-counting CT (PCCT) has the potential to enhance CCTA by offering improved spatial and temporal resolution (5,6), which could, in turn, refine CT-FFR analysis for more individualized patient care.

This study seeks to evaluate the potential of CT-FFR in assessing the hemodynamic significance of coronary artery stenoses at a lesion level using a PCCT dataset. The results will be compared with those obtained from clinically indicated ICA and the major adverse cardiovascular event (MACE) rate.