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Non-invasive patient selection for catheterisation

ESC Congress News 2015 - London


Pamela Douglas: Improved patient selection for invasive catheterisation from  fractional flow reserve measured by CTA.A diagnostic strategy using computed tomographic angiography (CTA) to measure fractional flow reserve (FFRct) in suspected coronary artery disease can triage patients more effectively for subsequent invasive procedures than usual care, according to the PLATFORM study reported as a Hot Line yesterday.

While current guidelines recommend that stable chest pain patients should be evaluated with non-invasive stress testing, rates of invasive angiograms showing no obstructive CAD remain high. The recent PROMISE and SCOT-HEART trials comparing anatomic and functional strategies found that CT angiography improved processes of care but increased rates of invasive catheterisation and revascularisation with no significant reductions in events. FFRct can be derived from CTA using computational algorithms that could address such limitations by providing non invasively both functional and anatomic data. The PLATFORM study, which was published simultaneously in the European Heart Journal, thus aimed to investigate use of a CTA/FFRCT-guided strategy as compared to standard practice in reducing the rate of invasive angiograms without increasing the occurrence of major cardiac events.

In this sequential non-randomised study 584 patients with new onset chest pain and suspected CAD were prospectively assigned to either usual testing or CTA/FFRct as the next step in their diagnostic work-up. The study was performed at 11 sites.

Results showed that 73.3% of those in the usual care group had angiograms without evidence of obstructive disease, while in the FFRCT population 61% of invasive angiograms were cancelled following receipt of information from FFCct, leaving 12.4 % to proceed to invasive angiograms. The difference in the number of patients having invasive angiograms in the two groups was statistically significant (P<0.0001). No differences were found for MACE, radiation or revascularization rates.            

‘Use of this combined anatomic and functional strategy employing CTA and FFRct was safe and improved patient selection for invasive catheterization,’ said study presenter Pamela Douglas, from Duke University School of Medicine in the USA.