Related Experiment Video
Updated: Mar 17, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study
Pamela S Douglas1, Bernard De Bruyne2, Gianluca Pontone3
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Insights
Coronary computed tomographic angiography (CTA) with fractional flow reserve (FFRCT) provides 1-year clinical outcomes equivalent to usual care for stable chest pain. This approach also significantly reduces healthcare costs in patients undergoing invasive coronary angiography.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Health Economics
Background:
- Coronary computed tomographic angiography (CTA) combined with fractional flow reserve derived from CTA (FFRCT) has demonstrated short-term efficacy in guiding stable chest pain management.
- Longer-term outcomes and economic impact of FFRCT remain less understood.
Purpose of the Study:
- To evaluate the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT compared to usual care in patients with stable chest pain.
- To determine the cost-effectiveness and impact on patient-reported outcomes of FFRCT-guided management.
Main Methods:
- A prospective study comparing CTA with selective FFRCT against usual care in 584 patients with stable chest pain.
- One-year follow-up included adjudication of major adverse cardiac events (MACE), assessment of total medical costs, and QOL surveys.
Main Results:
- At 1 year, MACE rates were similar between the FFRCT and usual care groups.
- In patients with planned invasive coronary angiography, FFRCT significantly reduced mean medical costs by 33% compared to usual care.
- Quality-of-life scores improved in both groups, with a statistically significant, though small, greater improvement in the EuroQOL scale for the FFRCT noninvasive group.
Conclusions:
- Care guided by CTA and selective FFRCT achieves equivalent 1-year clinical outcomes and QOL compared to usual care in patients with stable chest pain.
- FFRCT-guided management is associated with lower healthcare costs, particularly in patients with planned invasive coronary angiography.
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).
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease IV: Preventive Measures
01:20Angina V: Nursing Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT