Impact of an interactive CTCA/FFR_CT interventional stent planning tool on patient management

Fractional flow reserve (FFR) post percutaneous coronary intervention (PCI) is an important determinant of patient outcomes. A new virtual stent planning tool allows users to model PCI and obtain post PCI FFR_CT. We hypothesised that where a sub-optimal post PCI FFR_CT was predicted theoretical management may be altered prior to invasive angiography. Single-centre retrospective review of patients listed for PCI with preceding CTCA(+ FFR_CT), (Jan 2023-Sep 2024). Interventional cardiologists (ICs) at our institution determined a theoretical management strategy of (1) medical therapy (GDMT) (2) PCI or (3) multi-disciplinary team meeting (MDT) ± coronary artery bypass grafting (CABG) on a per-patient and per-vessel basis. The virtual stent planning tool was then unblinded and decision making repeated. Changes to management were compared with Wilcoxon-signed rank test and inter-rater agreement with Fleiss' free marginal kappa. 335 patients had a CTCA(+ FFR_CT), 96 clinically listed for angiography, 74 included in the study. 73% male, 66 ± 11 years. On a per-patient basis using CTCA(+ FFR_CT) data PCI was chosen in 95% of cases, GDMT in 4% and MDT ± CABG in 1%. The addition of the virtual planning tool changed management strategy to PCI in 59% of cases, GDMT in 30% and MDT in 11%, Wilcoxon-signed rank test P = 0.04. In patients scheduled to undergo clinically indicated PCI with preceding CTCA(+ FFR_CT) the use of the virtual stent planning tool significantly altered ICs theoretical management strategy upstream of invasive angiography, with a reduction in PCI, predominantly in favour of GDMT.