CTCA with selective FFRCT did not significantly differ from standard care in 9-month cardiac costs (difference +£114; P=0.10) but reduced invasive coronary angiography (19% vs 25%; P=0.01).
RCT (n=1,400)
Yes
Does an evaluation strategy based on initial CTCA with selective FFRCT reduce total cardiac costs at 9 months in patients with stable chest pain compared to standard clinical care?
A strategy of CTCA with selective FFRCT in patients with stable chest pain does not significantly change total cardiac costs or clinical outcomes at 9 months, but it significantly reduces the need for invasive coronary angiography.
Effect estimate: Difference +£114 (95% CI -£112 to +£337)
p-value: p=0.10
AIMS: Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. METHODS AND RESULTS: Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from -£112 (-8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). CONCLUSION: A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
“Results from FORECAST indicate that CTCA and FFRCT as a frontline strategy may not be associated with the financial savings projected from observational data by NICE. However, the reduction in invasive coronary angiography is important and will be very attractive to patients. More data is needed to determine the optimal use for FFRCT in clinical practice.”
Curzen et al. (Fri,) conducted a rct in stable chest pain (n=1,400). CTCA with selective FFRCT vs. standard clinical care pathways was evaluated on total cardiac costs at 9 months (Difference +£114, 95% CI -£112 to +£337, p=0.10). CTCA with selective FFRCT did not significantly differ from standard care in 9-month cardiac costs (difference +£114; P=0.10) but reduced invasive coronary angiography (19% vs 25%; P=0.01).