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01-08-2016 | Coronary heart disease | News | Article

Targeted CTA with FFR may cut costs without comprising outcomes

medwireNews: Coronary computed tomographic angiography (CTA) with estimation of fractional flow reserve (FFRCT) produces similar 1-year outcomes to usual care, and can save money in patients with a planned invasive strategy, shows further analysis of the PLATFORM trial.

The 380 patients with an initially planned invasive strategy had just four major adverse cardiac events (MACE) during 1 year of follow-up, two among the 193 who underwent FFRCT and two among the 187 given usual care.

Pamela Douglas (Duke University School of Medicine, Durham, North Carolina) and co-researchers stress that there were no MACE among the 117 patients who had a planned invasive coronary angiography (ICA) cancelled after assessment of FFRCT findings. Just four of these patients underwent later invasive testing and only one of these four required intervention, for a lesion that had progressed during follow-up.

The PLATFORM study, which involved 11 European centres, enrolled patients prospectively but did not randomise them. Instead, the first 287 patients enrolled received usual care and subsequent patients underwent FFRCT.

In patients with a planned invasive strategy, use of FFRCT reduced costs over 12 months by a significant 33% and cost savings persisted even if the cost of FFRCT was assumed to be 15 times that of CTA alone.

The cost benefits disappeared among the 204 patients with a planned noninvasive strategy, however, with a strategy based on FFRCT more expensive even if the test was assumed to be no more expensive than plain CTA, at US$ 3223 versus US$ 2579. These average costs were driven by increased use of invasive assessments in patients who underwent FFRCT, with the median per patient being much lower, at US$ 484 versus US$ 507.

Just one of these patients – in the usual care group – had a MACE during follow-up, reports the team in the Journal of the American College of Cardiology.

In an accompanying editorial, René Sevag Packard and Ronald Karlsberg, from the University of California in Los Angeles, USA, say the findings emphasise that “FFRCT should not be universally proposed to patients during [coronary artery disease] work-up but considered in patients designated to ICA.”

They also note that less than two-thirds of patients who underwent FFRCT ultimately had results available for clinical decision-making, meaning that many decisions were made purely on the basis of CTA. However, they say that their own experiences suggest that FFRCT is a better test than coronary CTA alone, particularly in cases with significant calcification, which they describe as the “Achilles’ heel of coronary CTA”.

But the editorialists stress that these comparisons should be made in rigorous randomised trials, as should comparisons between FFRCT and invasive FFR, before the noninvasive version can be more widely used.

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016