TY - JOUR
T1 - Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease
T2 - The prospective longitudinal trial of FFRCT: Outcome and resource impacts study
AU - Douglas, Pamela S.
AU - Pontone, Gianluca
AU - Hlatky, Mark A.
AU - Patel, Manesh R.
AU - Norgaard, Bjarne L.
AU - Byrne, Robert A.
AU - Curzen, Nick
AU - Purcell, Ian
AU - Gutberlet, Matthias
AU - Rioufol, Gilles
AU - Hink, Ulrich
AU - Schuchlenz, Herwig Walter
AU - Feuchtner, Gudrun
AU - Gilard, Martine
AU - Andreini, Daniele
AU - Jensen, Jesper M.
AU - Hadamitzky, Martin
AU - Chiswell, Karen
AU - Cyr, Derek
AU - Wilk, Alan
AU - Wang, Furong
AU - Rogers, Campbell
AU - De Bruyne, Bernard
N1 - Publisher Copyright:
© 2015 The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2015/12/14
Y1 - 2015/12/14
N2 - Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-Test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53-69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD.
AB - Aims In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFRCT) is unknown. Methods and results At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing (n = 287) or CTA/FFRCT (n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-Test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFRCT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFRCT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53-69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFRCT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFRCT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFRCT arms. Conclusions Computed tomographic angiography/fractional flow reserve by CTA was a feasible and safe alternative to ICA and was associated with a significantly lower rate of invasive angiography showing no obstructive CAD.
KW - Angina
KW - Coronary computed tomographic angiography
KW - Fractional flow reserve
KW - Non-invasive testing
UR - http://www.scopus.com/inward/record.url?scp=84944085387&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehv444
DO - 10.1093/eurheartj/ehv444
M3 - Article
C2 - 26330417
AN - SCOPUS:84944085387
SN - 0195-668X
VL - 36
SP - 3359
EP - 3367
JO - European Heart Journal
JF - European Heart Journal
IS - 47
ER -