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Impact on stable chest pain pathways of CT fractional flow reserve

Rachel A O'Leary1, Julie Burn1, Samuel G Urwin1

  • 1Northern Medical Physics and Clinical Engineering, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.

Heart (British Cardiac Society)
|April 20, 2023
PubMed

Insights

Introducing CT fractional flow reserve (FFRCT) improved stable chest pain pathway efficiency and guideline adherence. This diagnostic tool reduced invasive procedures and unnecessary tests, streamlining patient care without affecting revascularisation rates.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Health Services Research

Background:

  • Stable chest pain management pathways aim for efficient diagnosis and treatment.
  • National Institute for Health and Care Excellence (NICE) guidelines provide a framework for chest pain assessment.
  • CT fractional flow reserve (FFRCT) is a non-invasive imaging technique for assessing coronary artery disease.

Purpose of the Study:

  • To evaluate the impact of integrating FFRCT into rapid access chest pain clinic (RACPC) pathways.
  • To assess changes in guideline concordance, resource utilization, and revascularisation rates post-FFRCT implementation.
  • To compare patient outcomes before and after the introduction of FFRCT in a tertiary UK cardiac centre.

Main Methods:

  • A single-centre, before-and-after study design was employed.
  • Data were collected from electronic records and the Strategic Tracing Service for RACPC patients.
  • Patient cohorts from pre-FFRCT (July-Dec 2017) and post-FFRCT (Aug 2018-Jan 2019) periods were compared.

Main Results:

  • First-line CT coronary angiography (CTCA) use increased significantly post-FFRCT (50.6% vs 75.7%).
  • More patients reached a diagnostic endpoint after a single investigation (74.9% vs 84.9%).
  • There was a reduction in stress/rest myocardial perfusion scans and diagnostic-only angiograms, leading to fewer invasive procedures (29.3% vs 17.6%) and inpatient admissions (39.0% vs 24.3%). Revascularisation rates and time to revascularisation remained similar.

Conclusions:

  • FFRCT adoption enhanced compliance with NICE guidelines for chest pain management.
  • The introduction of FFRCT led to reduced use of invasive diagnostic angiography and fewer planned admissions.
  • FFRCT streamlined diagnostic pathways, reducing the need for multiple investigations to reach a management endpoint.
Abstract

Keywords:
chest paincomputed tomography angiographycoronary artery diseasecoronary stenosispercutaneous coronary intervention

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