Computed tomography-derived fractional flow reserve (CT-FFR) is an emerging tool allowing for noninvasive physiological assessment and risk stratification of patients with coronary artery disease (CAD). However, the long-term prognostic impact of negative CT-FFR (CT-FFR >0.80) in patients with stable CAD requires further investigation. In this systematic review and meta-analysis, a comprehensive search was conducted across PubMed, Embase, Web of Science, and Scopus to identify studies comparing clinical outcomes in patients with stable CAD and CT-FFR >0.80 or ≤0.80, published up to October 15, 2025. Individual patient data were reconstructed by processing the extracted time points, survival probabilities, and the number of patients at risk from Kaplan-Meier curves. The pooled survival curves and Cox proportional hazard model were fitted to estimate HRs and 95% CIs. The restricted mean survival time (RMST) was also calculated as the area under the survival curve for each group. Of the 17 included studies, 15 comprising 14,315 patients were used in the IPD-reconstructed meta-analysis of incident Major adverse cardiovascular events (MACE) or a composite of all-cause mortality and non-fatal MI. Over a follow-up period of up to 120 months, CT-FFR ≤0.80 was associated with a 197% increased risk of MACE compared to those with CT-FFR >0.80 (HR: 2.97; 95% CI: 2.54-3.48; p < 0.001). The 10-year MACE-free survival rate was 77.1% in the CT-FFR ≤0.80 group versus 91.4% in the CT-FFR >0.80 group. RMST analysis revealed that over this period, Patients with CT-FFR >0.80 had a mean MACE-free survival of 114.1 months, compared to 94.8 months in those with CT-FFR ≤0.80 (p < 0.001). Patients with stable CAD and CT-FFR >80 can be safely deferred from invasive evaluations in the absence of other indications, due to their high rates of long-term MACE-free survival.

Post-operative venous thromboembolism (VTE) remains a concern following cancer-related surgeries. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of direct oral anticoagulants (DOACs) compared to low molecular weight heparin (LMWH) for thromboprophylaxis after cancer-related surgeries. We systematically searched databases for studies comparing DOACs to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries. Primary outcomes were VTE incidence and bleeding events. Secondary outcomes included all-cause mortality and hospitalization rates. Subgroup analyses examined DOAC type, cancer type, and follow-up duration. A random-effects model calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs). Analysis included 16 studies with 6400 participants in the DOAC group (mean age 62.05 years, 28.15 % male) and 5801 participants in the LMWH group (mean age 60.78 years, 34.65 % male). DOACs were non-inferior to LMWH for VTE prevention (RR = 0.81, 95 % CI 0.56 to 1.16) with no significant difference in bleeding rates (RR = 0.70, 95 % CI 0.70 to 1.18). Mortality and hospitalization rates were similar between groups. Subgroup analyses suggested possible VTE reduction with DOACs in urological cancer surgeries (RR = 0.52, 95 % CI 0.44 to 0.61) and lower bleeding trends with Apixaban (RR = 0.64, 95 % CI 0.44 to 0.94). DOACs appear non-inferior to LMWH for post-operative thromboprophylaxis in patients undergoing cancer-related surgeries, with comparable safety. The superior VTE prevention in urological cancer surgeries and Apixaban's favorable safety profile warrant further investigation. Moreover, additional research is necessary to clarify the roles of specific DOACs and optimal prophylaxis strategies across various cancer types and surgical procedures.