Clinical and economic impact of FFR-CT-guided decision making in patients with moderate coronary disease

Introduction Fractional flow reserve-computed tomography (FFR-CT) is a new tool to improve diagnostic accuracy. However, its impact in Spain remains untested. Purpose This study evaluates the clinical and economic implications of incorporating FFR-CT into routine practice in Spain, versus standard approach, in patients with moderate coronary stenosis. Methods This is a retrospective, observational, single-center intervention simulation study conducted on patients with stable chest pain who underwent a coronary CT angiography (July 2021 -December 2022) in Spain. Patients were eligible if they had a CAD-RADS 2.0 grading system of 3 (50–69% stenosis), body mass index <35 kg/m2 and coronary artery calcium score < 1000 Agatston Units. The CT report was provided to five clinical cardiologists, who reviewed independently the findings and made decisions on any additional tests or interventions they felt were necessary. This process was repeated after applying FFR-CT, with the same set of questions asked to evaluate how their decisions changed based on the additional information from FFR-CT. For each clinical scenario, the cardiologists were asked to respond to a set of questions, both before and after FFR-CT analysis: (1) What additional diagnostic tests would you request? (2) Would you recommend admission, outpatient management, or discharge? (3) What treatment approach would you suggest based on the available results? (4) Did you find the information provided by FFR-CT to be useful?. The cost analysis assessed the total cost or savings resulting from these decisions. Results In the clinical simulation analysis, a total of 215 clinical scenarios were finally evaluated, corresponding to the individual assessment of all 43 cases by each of the 5 participating cardiologists. FFR-CT substantially reduced the need for additional tests. Stress cardiac magnetic resonance dropped from 54.8% to 12% (p=0.00), while invasive coronary angiography decreased from 21% to 15% (p=0.00). The total cost savings of diagnostic procedures after FFR-CT amounted to 45,976.64 euros, or 213.84 euros per case. Notably, end of diagnostic process increased from 11% to 48% after its implementation (p=0.00) Conclusions According to the results of this simulation study, FFR-CT was associated with a significantly lower rate of additional testing, substantial cost savings, and a higher discharge rate.Graphical abstract Table 1.Cost analysis