Early clinical and economic impact of integrating FFR-CT into a coronary computed tomography angiography pathway: interim results from a pragmatic Polish implementation programme

Background CCTA is increasingly used as a first-line test for suspected stable coronary artery disease, but anatomically “intermediate” findings often trigger invasive coronary angiography (ICA) despite uncertain haemodynamic relevance. In practice, the value of CT-FFR is to reduce nonactionable ICAs, improving system efficiency and minimising invasive diagnostics. However, real-world CCTA/CT-FFR implementation is frequently non-standardised (variable downstream decision ownership across radiology/cardiology), which may dilute clinical impact. Purpose To test the hypothesis that achieving the intended benefit of CT-FFR requires a structured pathway with competency-based clinical qualification, and to report interim results of a pragmatic implementation model supporting national reimbursement planning. Methods Prospective, pragmatic observational implementation at the National Institute of Cardiology. Consecutive patients were pre-screened; inclusion required: (1) eligibility by clinical criteria, (2) diagnostic-quality CCTA (minimum “good” quality; Likert ≥2), and (3) 50-90% stenosis in a potentially revascularisable coronary artery. Importantly, final qualification (conservative management vs ICA with intent to revascularise) was performed within a predefined algorithm by a cardiologist with the competence to qualify for PCI/CABG, integrating symptoms, CCTA anatomy and CT-FFR. Interim analysis: 01 Aug 2025–31 Dec 2025. Key outcomes: (i) proportion of ICA without revascularisation (primary), (ii) single-day discharge PCI rate, (iii) early safety in conservatively managed patients, and (iv) payer-perspective budget impact (NFZ tariffs). Results >1000 patients were pre-screened; 229 met eligibility criteria and 174 underwent CT-FFR. Based on the structured algorithm, 88/174 (51%) were directed to an invasive strategy. At the time of interim analysis, 46/88 had undergone ICA (intent to treat): 29/46 proceeded to ad hoc PCI, and 16/29 (51%) of ad hoc PCI were performed with single-day discharge. ICA without revascularisation occurred in 11/46 (24%), representing a marked reduction versus the historically reported ~50% rate in the prevailing CCTA→ICA model in Poland. No unplanned revascularisations were observed among patients assigned to conservative management during early follow-up. A tariff-based model estimated a direct NFZ cost reduction of ≈3,465–3,695 PLN saved per patient. Conclusion In interim results, a structured, cardiologist-led CCTA+CT-FFR pathway—with explicit entry criteria (patient eligibility + diagnostic CCTA + revascularisable vessel with ≥50% stenosis) and ownership of downstream qualification—delivered the intended system-level benefit of CT-FFR, namely fewer non-therapeutic ICA procedures, with high feasibility, frequent single-day discharge PCI, and no early safety signal in conservatively managed patients. The full multicentre dataset and complete analysis will be presented at ESC Congress 2026.