1-Year Outcomes of FFR_CT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study

Background Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFR_CT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown. Objectives The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFR_CT instead of usual care. Methods Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFR_CT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL. Results Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFR_CT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFR_CT cost weight of zero ($3,049 FFR_CT vs. $2,579; p = 0.82), but were higher when using an FFR_CT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFR_CT vs. 0.07 for usual care; p = 0.02). Conclusions In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFR_CT was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up.