AbstractBackgroundTo examine the utility of fractional flow reserve by coronary computed tomography (CT) angiography (FFRCT) for predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD).MethodsThis was a nationwide multicenter prospective cohort study including consecutive 1187 patients aged 50−74 years with suspected CAD and had available coronary CT angiography (CCTA). In patients with ≥50% coronary artery stenosis (CAS), FFRCTwas further analyzed. The Cox proportional hazards model was used to examine the association of FFRCTand cardiovascular risk factors with incident MACE within 2 years.ResultsAmong 933 patients with available information on MACE within 2 years after enrollment, the incidence rate of MACE was higher in 281 patients with CAS than in those without CAS (6.11 vs. 1.16 per 100 patient‐year). In 241 patients with CAS, the Cox proportional hazards analysis showed that FFRCTas well as diabetes mellitus and low high‐density lipoprotein cholesterol level were independently associated with incident MACE. Moreover, the hazard ratio was significantly higher in patients harboring all three factors compared to those harboring 0−2 of the three factors (6.01; 95% confidence interval: 2.77−13.03).ConclusionsCombinatorial assessment using CCTA for stenosis, FFRCT, and risk factors was useful for more accurate prediction of MACE in patients with suspected CAD. Among patients with CAS, those with lower FFRCT, diabetes mellitus, and low high‐density lipoprotein cholesterol level were at highest risk for MACE during the 2‐year period following enrollment.