Projected Costs and Consequences of Computed Tomography‐Determined Fractional Flow Reserve. Issue 12 (1st October 2013)

• Record Type: Journal Article
• Authors: Hlatky, Mark A.; Saxena, Akshay; Koo, Bon‐Kwon; Erglis, Andrejs; Zarins, Christopher K.; Min, James K.
• Is Part Of: Clinical cardiology. Volume 36:Issue 12(2013:Dec.)
• Page Start: 743
• Page End: 748
• Publication Date: 2013-10-01
• Subjects: Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.22205
• Languages: English
• ISSNs: 0160-9289

Abstract

<abstract abstract-type="main" id="clc22205-abs-0001"> <title>Abstract</title> <sec id="clc22205-sec-0001" sec-type="section"> <title>Background</title> <p id="clc22205-para-0001">Randomized trials have shown that fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) improves clinical outcome and reduces costs compared with visually guided PCI. FFR has been measured during invasive coronary angiography (ICA), but can now be derived noninvasively from coronary computed tomography (CT) angiography (cCTA) images (FFR<sub>CT</sub>). The potential value of FFR<sub>CT</sub> in clinical decision making is unknown.</p> </sec> <sec id="clc22205-sec-0002" sec-type="section"> <title>Hypothesis</title> <p id="clc22205-para-0002">Use of FFR<sub>CT</sub> can reduce costs and improve outcomes among patients with suspected coronary artery disease.</p> </sec> <sec id="clc22205-sec-0003" sec-type="section"> <title>Methods</title> <p id="clc22205-para-0003">We used clinical data from 96 patients in the DISCOVER‐FLOW (Diagnosis of Ischemia‐Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and outcomes data from the literature to project the initial management costs and 1‐year death/myocardial infarction rates associated with 5 clinical strategies: (1) ICA with PCI based on visual angiographic assessment, (2) ICA with FFR<sub>ICA</sub>‐guided PCI, (3) cCTA followed by ICA and PCI based on visual assessment, (4) cCTA followed by ICA with FFR<sub>ICA</sub>‐guided PCI, and (5) cCTA FFR<sub>CT</sub> and PCI of lesions with FFR<sub>CT</sub> ≤0.80.</p> </sec> <sec id="clc22205-sec-0004" sec-type="section"> <title>Results</title> <p id="clc22205-para-0004">The projected initial management costs were highest for the ICA/visual strategy ($10 702), and lowest for the cCTA/FFR<sub>CT</sub>/ICA strategy ($7674). The use of FFR<sub>CT</sub> to select patients for ICA and PCI would result in 30% lower costs and 12% fewer events at 1 year compared with the most commonly used ICA/visual strategy.</p> </sec> <sec id="clc22205-sec-0005" sec-type="section"> <title>Conclusions</title> <p id="clc22205-para-0005">A strategy of using FFR<sub>CT</sub> to guide the selection of patients for ICA and PCI might reduce costs and improve clinical outcomes in patients with suspected coronary artery disease.</p> </sec> </abstract>