PLATFORM: Cost and Quality of Life Outcomes in Stable Suspected CAD Patients

Evaluating fractional flow reserve estimated by coronary tomography (CT) may lower costs and resource use in stable patients with suspected coronary artery disease (CAD), according to the results of the PLATFORM trial, presented Oct. 13 at TCT 2015 and simultaneously published in the Journal of the American College of Cardiology.

Mark A. Hlatky, MD, FACC, et al., sought to determine the economic and quality of life benefits of evaluating stable patients with suspected CAD through fractional flow reserve estimated by CT, compared with usual care. In this multi-center, prospective, non-randomized study, 100 patients were evaluated with non-invasive testing, while 104 were evaluated with fractional flow reserve estimated by CT. In the invasive testing group, 187 patients received the usual care strategy and 193 patients were evaluated by fractional flow reserve estimated by CT.

The results of the study show that evaluation of fractional flow reserve estimated by CT is associated with lower costs and improved quality of life in stable suspected CAD patients, compared to evaluation with invasive coronary angiography and other noninvasive testing, respectively. Evaluation of these patients with fractional flow reserve estimated by CT also resulted in lower use of medical resources, compared to invasive coronary angiography.

According to Hlatky, et al., “these findings suggest that the combination of anatomic and functional data provided by the fractional flow reserve estimated by CT guided testing strategy may lead to more selective use of invasive procedures than relying solely on the anatomic data provided by invasive coronary angiography.”

However, in an accompanying editorial comment, Edward Hulten, MD, FACC, and Marcelo F. Di Carli, MD, FACC, state that “clinicians will not choose between fractional flow reserve estimated by CT versus direct referral to invasive coronary angiography … especially among low-intermediate risk patients with stable symptoms. Rather, the clinical choice would be between coronary computed tomography angiography plus fractional flow reserve estimated by CT versus stress testing.”

Hulten and Di Carli add that “the use of stress testing would have resulted in a similar reduction in the number of unnecessary invasive coronary angiographies.” 

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Arteries, Coronary Angiography, Coronary Artery Disease, Coronary Disease, Quality of Life, Tomography, X-Ray Computed

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