The use and efficacy of FFR-CT: Real-world multicenter audit of clinical data with cost analysis
Deshpande, Aparna Elfawal, Sara
Deshpande, Aparna
Elfawal, Sara
Abstract
Background: Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown.
Objectives: To audit the use of FFR-CT in clinical practice against England's National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost.
Methods: A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling.
Results: A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging.
Conclusions: In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies.
MIDER Authors
Citations
Altmetric:
Date
Type
Article
Subject
FFR-CT, Coronary CT angiography, Stable chest pain
Collections
Citation
Mittal, T. K., Hothi, S. S., Venugopal, V., Taleyratne, J., O'Brien, D., Adnan, K., Sehmi, J., Daskalopoulos, G., Deshpande, A., Elfawal, S., Sharma, V., Shahin, R. A., Yuan, M., Schlosshan, D., Walker, A., Abdel Rahman, S. E., Sunderji, I., Wagh, S., Chow, J., Masood, M., … Kelion, A. D. (2023). The Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis. JACC. Cardiovascular imaging, S1936-878X(23)00099-2. Advance online publication. https://doi.org/10.1016/j.jcmg.2023.02.005