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1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: The PLATFORM Study

1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: The PLATFORM Study
1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: The PLATFORM Study

BACKGROUND: Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown.

OBJECTIVES: The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care.

METHODS: Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL.

RESULTS: Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFRCT cost weight of zero ($3,049 FFRCT vs. $2,579; p = 0.82), but were higher when using an FFRCT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFRCT vs. 0.07 for usual care; p = 0.02).

CONCLUSIONS: In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFRCT was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up. (The PLATFORM Study: Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts [PLATFORM]; NCT01943903).

Computed Tomography Angiography/methods, Coronary Angiography/methods, Coronary Artery Disease/diagnosis, Female, Follow-Up Studies, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Quality of Life, Time Factors
0735-1097
435-445
Douglas, Pamela S.
b282b64d-d5f2-4cc3-b832-9b8d52009e0c
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e
Pontone, Gianluca
a38cc1ea-5dba-4a34-80e9-478556029dad
Patel, Manesh R.
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Norgaard, Bjarne L.
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Byrne, Robert A.
85863b99-534c-4bfd-8a36-3cdb796c0882
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Purcell, Ian
d38e7a5f-fe49-4599-a47f-cca3b8d593dd
Gutberlet, Matthias
e77cfb43-d42e-46b1-8fa3-eae2ca72d609
Rioufol, Gilles
87163c97-9ed4-477a-9692-6ac8506fcd9f
Hink, Ulrich
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Schuchlenz, Herwig Walter
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Feuchtner, Gudrun
32f34428-460b-4cbf-80e8-ffdd50d340a3
Gilard, Martine
feae684c-07b6-4e93-8fd8-234d0941c82d
Andreini, Daniele
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Jensen, Jesper M
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Hadamitzky, Martin
4f6b7e2d-e7d2-4ec7-81b3-43de27ebf118
Chiswell, Karen
8e116401-036a-4ece-b774-2b79d67f1596
Cyr, Derek
e3594755-f98e-4dcd-ac51-a10ce74a6f7f
Wilk, Alan
ea4fa3ae-1396-45f3-a371-bcfdc8dfb88b
Wang, Furong
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Rogers, Campbell
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Hlatky, Mark A.
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PLATFORM Investigators
Douglas, Pamela S.
b282b64d-d5f2-4cc3-b832-9b8d52009e0c
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e
Pontone, Gianluca
a38cc1ea-5dba-4a34-80e9-478556029dad
Patel, Manesh R.
d4bc16f4-6708-401e-8301-6ab5fe9bb8b7
Norgaard, Bjarne L.
5bd2107d-613f-4cff-a1f7-ca08b22c04eb
Byrne, Robert A.
85863b99-534c-4bfd-8a36-3cdb796c0882
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Purcell, Ian
d38e7a5f-fe49-4599-a47f-cca3b8d593dd
Gutberlet, Matthias
e77cfb43-d42e-46b1-8fa3-eae2ca72d609
Rioufol, Gilles
87163c97-9ed4-477a-9692-6ac8506fcd9f
Hink, Ulrich
eedfda99-4266-4c6a-97c0-a05c0e6e9835
Schuchlenz, Herwig Walter
523fa731-6c32-41e6-a944-f7d715816f42
Feuchtner, Gudrun
32f34428-460b-4cbf-80e8-ffdd50d340a3
Gilard, Martine
feae684c-07b6-4e93-8fd8-234d0941c82d
Andreini, Daniele
e8194b12-290b-47f8-a274-abf0945f2480
Jensen, Jesper M
7ff59220-d85e-421e-a837-b1b70f3a7550
Hadamitzky, Martin
4f6b7e2d-e7d2-4ec7-81b3-43de27ebf118
Chiswell, Karen
8e116401-036a-4ece-b774-2b79d67f1596
Cyr, Derek
e3594755-f98e-4dcd-ac51-a10ce74a6f7f
Wilk, Alan
ea4fa3ae-1396-45f3-a371-bcfdc8dfb88b
Wang, Furong
08648899-449a-4243-a58b-6aa3186b4926
Rogers, Campbell
30ecce2e-9a3e-4e7f-9280-8511a5865eda
Hlatky, Mark A.
43f00437-a3e4-4f81-aed9-5b0ca52cd86e

Douglas, Pamela S., De Bruyne, Bernard, Pontone, Gianluca, Patel, Manesh R., Norgaard, Bjarne L., Byrne, Robert A., Curzen, Nick, Purcell, Ian, Gutberlet, Matthias, Rioufol, Gilles, Hink, Ulrich, Schuchlenz, Herwig Walter, Feuchtner, Gudrun, Gilard, Martine, Andreini, Daniele, Jensen, Jesper M, Hadamitzky, Martin, Chiswell, Karen, Cyr, Derek, Wilk, Alan, Wang, Furong, Rogers, Campbell and Hlatky, Mark A. , PLATFORM Investigators (2016) 1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: The PLATFORM Study. Journal of the American College of Cardiology, 68 (5), 435-445. (doi:10.1016/j.jacc.2016.05.057).

Record type: Article

Abstract

BACKGROUND: Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown.

OBJECTIVES: The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care.

METHODS: Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL.

RESULTS: Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFRCT cost weight of zero ($3,049 FFRCT vs. $2,579; p = 0.82), but were higher when using an FFRCT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFRCT vs. 0.07 for usual care; p = 0.02).

CONCLUSIONS: In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFRCT was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up. (The PLATFORM Study: Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts [PLATFORM]; NCT01943903).

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Accepted/In Press date: 3 May 2016
e-pub ahead of print date: 25 July 2016
Published date: 2 August 2016
Keywords: Computed Tomography Angiography/methods, Coronary Angiography/methods, Coronary Artery Disease/diagnosis, Female, Follow-Up Studies, Fractional Flow Reserve, Myocardial, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Quality of Life, Time Factors

Identifiers

Local EPrints ID: 436147
URI: http://eprints.soton.ac.uk/id/eprint/436147
ISSN: 0735-1097
PURE UUID: c9ab765a-22fb-4d1e-885e-ec977f613226
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 29 Nov 2019 17:30
Last modified: 02 Jul 2022 01:42

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Contributors

Author: Pamela S. Douglas
Author: Bernard De Bruyne
Author: Gianluca Pontone
Author: Manesh R. Patel
Author: Bjarne L. Norgaard
Author: Robert A. Byrne
Author: Nick Curzen ORCID iD
Author: Ian Purcell
Author: Matthias Gutberlet
Author: Gilles Rioufol
Author: Ulrich Hink
Author: Herwig Walter Schuchlenz
Author: Gudrun Feuchtner
Author: Martine Gilard
Author: Daniele Andreini
Author: Jesper M Jensen
Author: Martin Hadamitzky
Author: Karen Chiswell
Author: Derek Cyr
Author: Alan Wilk
Author: Furong Wang
Author: Campbell Rogers
Author: Mark A. Hlatky
Corporate Author: PLATFORM Investigators

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