Key result
Virtual stent planning is linked to a ~38% reduction in decisions for PCI over medical therapy.
Why the study?
Does a virtual stent planning tool alter theoretical management strategy in patients scheduled for PCI with preceding CTCA(+FFRCT)?
Observational (n=74)
No
Does a virtual stent planning tool alter theoretical management strategy in patients scheduled for PCI with preceding CTCA(+FFRCT)?
The use of an interactive CTCA/FFRCT virtual stent planning tool significantly altered theoretical management strategies, reducing planned PCIs in favor of medical therapy.
Background Fractional flow reserve (FFR) post percutaneous coronary intervention (PCI) is an important determinant of patient outcomes. A new virtual stent planning tool allows users to model PCI and obtain post PCI FFRCT. Purpose We hypothesised that where a sub-optimal post PCI FFRCT was predicted theoretical management may be altered prior to invasive angiography. Methods Single-centre retrospective review of patients listed for PCI with preceding CTCA(+FFRCT), (Jan 2023-Sep 2024). Interventional cardiologists (ICs) at our institution determined a theoretical management strategy of 1) medical therapy (GDMT) 2) PCI or 3) multi-disciplinary team meeting (MDT) ±coronary artery bypass grafting (CABG) on a per-patient and per-vessel basis. The virtual stent planning tool was then unblinded and decision making repeated. Changes to management were compared with Wilcoxon-signed rank test and inter-rater agreement with Fleiss’ free marginal kappa. Results 335 patients had a CTCA(+FFRCT), 96 clinically listed for angiography, 74 included in the study. 73% male, 66 ±11 years. On a per-patient basis using CTCA(+FFRCT) data PCI was chosen in 95% (70/74) of cases, GDMT in 4% (3/74) and MDT±CABG in 1% (1/74). The addition of the virtual planning tool changed management strategy to PCI in 59% (44/74) of cases, GDMT in 30% (22/74) and MDT in 11% (8/74), Wilcoxon-signed rank test P= .04. Conclusion In patients scheduled to undergo clinically indicated PCI with preceding CTCA(+FFRCT) the use of the virtual stent planning tool significantly altered ICs theoretical management strategy upstream of invasive angiography, with a reduction in PCI, predominantly in favour of GDMT.
No takes yet. Share an insight, caveat, or question.
Murphy et al. (2025) conducted an observational in Patients listed for percutaneous coronary intervention (n=74). Virtual stent planning tool vs. CTCA(+FFRCT) alone was evaluated on Theoretical management strategy of PCI (p=.04). The use of a virtual stent planning tool significantly altered theoretical management strategy, reducing the decision for PCI from 95% to 59% in favor of medical therapy (P=0.04).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: