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Effect of FFRCT on Patient Management
Study Questions:
What is the effect of fractional flow reserve derived from computed tomography (FFRCT) on the management plan of patients in comparison to the use of coronary computed tomographic angiography (CCTA) alone?
Methods:
The study examined 200 patients with stable chest pain imaged by CCTA in whom FFRCT was also measured, and compared the management plan determined by a consensus of three interventional cardiologists using CCTA findings alone in comparison to the plan based on FFRCT and CCTA data. Strategies included: 1) more data required, 2) optimal medical therapy, 3) percutaneous coronary intervention, and 4) coronary artery bypass surgery.
Results:
Using CCTA alone, the four strategies were selected in 19%, 34%, 44%, and 4% of patients, respectively; with the addition of FFRCT data, these strategies were selected for 0%, 57%, 39%, and 5%, respectively. Using CCTA stenosis thresholds of 1-29%, 30-50%, 51-70%, 71-90%, and >90%, a low FFRCT measurement was reported in 3%, 6%, 23%, 54%, and 70% of vessels, respectively.
Conclusions:
The addition of FFRCT results to CCTA results alone resulted in a change in planned patient management among a consensus of interventional cardiologists, predominantly due to a decrease in the number of patients in whom more information was required and an increase in the number of patients planned for optimal medical therapy.
Perspective:
FFRCT is a technology that aims to improve the noninvasive assessment of coronary artery lesions, as the addition of this to CCTA could permit simultaneous measurement of an anatomic stenosis and its functional significance. These results demonstrate that the incorporation of FFRCT results into CCTA findings can change patient management, at least among the group of interventional cardiologists participating in this study. These cardiologists appear to have high confidence in these results (despite the moderate accuracy of FFRCT in comparison to invasive FFR), as they decided that none of the patients needed additional testing after the addition of FFRCT data. Interestingly, the bulk of the change for FFRCT was due to shifting of patients from planned additional testing (changed from 19% to 0%) to plans for optimal medical management (changed from 34% to 57%), with a negligible change in the number of patients planned for revascularization. These results are interesting, but it is unclear whether other cardiologists would make similar decisions. Further, the outcomes of such a change in strategy remain unknown.
Keywords: Angina, Stable, Angiography, Chest Pain, Constriction, Pathologic, Coronary Artery Bypass, Diagnostic Imaging, Fractional Flow Reserve, Myocardial, Patient Care Management, Percutaneous Coronary Intervention, Tomography, X-Ray Computed
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