Author + information
- Mark Rabbat,
- Brian Kauh,
- Gianluca Pontone,
- Bjarne Norgaard,
- John Lopez and
- Verghese Mathew
Background: In the U.S., real world feasibility and economic impact of a diagnostic strategy using coronary computed tomography (CT)-derived fractional flow reserve (FFRCT) in symptomatic patients suspected to have coronary artery disease (CAD) is unknown. We sought to determine whether the use of a CT plus FFRCT guided strategy as compared to CT alone reduces rates of invasive coronary angiography (ICA) without increasing adverse cardiac events and cost of care.
Methods: 202 consecutive symptomatic patients with suspected CAD referred for CT / FFRCT over a 12-month period at Loyola University Chicago were included. Lesions of intermediate (30-90%) stenosis were considered for our analysis. FFRCT ≤0.80 was considered diagnostic of lesion-specific ischemia. Rates of ICA, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and adverse events of death, myocardial infarction or urgent revascularization were recorded. Cost weights of CT ($301) and ICA ($2,838) from Medicare were used for economic analysis. We assigned a $1,500 cost of the FFRCT analysis.
Results: Mean age was 59 years and 46% of patients were men. Comorbidities included hypertension in 58%, diabetes in 16%, and hyperlipidemia in 65%. Ninety one of 202 patients had intermediate CAD by CT. FFRCT results were able to be performed in 79 of 91 (87%) patients with intermediate CAD. Thirty one of 79 (39%) of patients had >1 vessel with FFRCT ≤0.80. Twenty two patients underwent ICA and 15 were revascularized (10 PCI, 5 CABG). In our practice, 91 ICA would have resulted in this cohort of symptomatic patients based off anatomic severity of CAD by a CT-only guided strategy. FFRCT reduced the number of unnecessary ICA by 63% (57 of 91). There were no adverse events during a mean follow-up of 163 days. As compared to CT alone, costs in the CT/ FFRCT strategy were 14% lower ($1,567 vs. $1,355; p=0.001), even after accounting for the cost of FFRCT.
Conclusions: A diagnostic strategy of CT/ FFRCT was associated with less ICA in symptomatic patients with intermediate CAD, with no adverse events during follow-up, and at lower cost than a CT-only guided strategy.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-333
- 2017 American College of Cardiology Foundation