Computed tomographic angiography/fractional flow reserve (CTA/FFR_CT) was a feasible and safe alternative to invasive coronary angiography (ICA) and was associated with a significantly lower rate of ICA showing no obstructive coronary artery disease (CAD), according to results from the PLATFORM trial presented Sept. 1 during ESC Congress 2015 in London and simultaneously published in European Heart Journal.

The study prospectively assigned 584 patients from 11 sites in Europe to receive either usual testing or CTA/FFR_CT to determine whether CTA/FFR_CT could reduce the rate of ICAs with no obstructive CAD. From there, patients were divided into those whom "usual care" would dictate a non-invasive treatment such as stress testing or conventional CTA, or those who would have proceeded straight to ICA. 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 was found at ICA within 90 days. Secondary endpoints included death, myocardial infarction and unplanned revascularization.

Results found that among those patients already scheduled for an ICA, no obstructive CAD was found at the time of the procedure in 12 percent of those in the CTA/FFR_CT group, compared to 73 percent in the group undergoing usual testing. Additionally, ICA was cancelled in 61 percent of patients after receiving CTA/FFR_CT results. Investigators also noted that while CTA/FFR_CT reduced the number of patients who underwent an ICA that found no significant disease, clinical event rates within 90 days were low in both groups.

"The study shows that CTA plus FFR_CT more effectively triages patients for invasive procedures than usual care strategies," said Pamela S. Douglas, MD, MACC, the Ursula Geller Professor at the Duke Clinical Research Institute, Duke University School of Medicine, in Durham, NC, and a past president of the ACC. "Although CTA/FFR_CT is a relatively new technique, PLATFORM demonstrates that it is feasible and safe with high utility in busy clinical settings."

Douglas and her fellow investigators also note that PLATFORM adds substantially to both the PROMISE and the SCOT-HEART trials. "Like these studies, PLATFORM provides prospective data essential to evaluating and optimizing the role of non-invasive testing as a gatekeeper to catheterization," they said.

Keywords: ESC Congress, Arteries, Coronary Angiography, Coronary Artery Disease, Coronary Disease, Prospective Studies

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