Results:

Overall, 2,494 patients were screened and 16% were excluded for not meeting inclusion criteria (including CTA contraindications), 8% for patient preference, and 19% for other reasons. Of 1,400 subjects randomized (700 to CT-FFR, 700 to standard care), most patients received the allocated interventions. Most patients allocated to the CT-FFR arm did not require CT-FFR, as coronary CTA alone was sufficient (n = 494, 64.9%). Most patients in the standard care arm also underwent coronary CTA (n = 430, 61.4%). The second most common initial test was stress echocardiography (n = 103, 14.7%). In the standard care arm, 47 patients went directly for invasive angiography, though none did in the CT-FFR arm.

After 9 months, total cardiac care costs were higher in the CT-FFR arm by £114, though this was not statistically significant. Total coronary angiography was lower in the CT-FFR arm (156 vs. 182, p = 0.01), though percutaneous coronary intervention (PCI) was numerically but not statistically higher (88 vs. 75, p = 0.66). There was also a nonstatistically significant increase in myocardial infarctions (MIs) in the CT-FFR group (10 vs. 3, p = 0.09), though other hospitalizations and emergency department visits were lower. Medication use was similar in both arms. There were no differences in quality of life or angina between treatment groups. For stratified analyses among pre-randomization treatment plan (i.e., invasive angiography, stress testing, or coronary CTA), there were no significant differences.