作者
Tarun Mittal,Sandeep S Hothi,Vinod Venugopal,John Taleyratne,David O’Brien,Kazi Adnan,Joban Sehmi,Georgios Daskalopoulos,Aparna Deshpande,Sara Elfawal,Vinoda Sharma,Rajai A. Shahin,Mingyang Yuan,Dominik Schlosshan,Andrew Walker,Saif-El-Dean Abdel Rahman,Imran Sunderji,Sidhesh B Wagh,Jocelyn Chow,Mohammed Masood,Sumeet Sharma,Sharad Agrawal,Chary Duraikannu,Elisa McAlindon,Saeed Mirsadraee,Edward Nicol,Andrew Kelion
摘要
Fractional flow reserve-computed tomography (FFR-CT) is endorsed by UK and U.S. chest pain guidelines, but its clinical effectiveness and cost benefit in real-world practice are unknown.The purpose of this study was to audit the use of FFR-CT in clinical practice against England's National Institute for Health and Care Excellence guidance and assess its diagnostic accuracy and cost.A multicenter audit was undertaken covering the 3 years when FFR-CT was centrally funded in England. For coronary computed tomographic angiograms (CCTAs) submitted for FFR-CT analysis, centers provided data on symptoms, CCTA and FFR-CT findings, and subsequent management. Audit standards included using FFR-CT only in patients with stable chest pain and equivocal stenosis (50%-69%). Diagnostic accuracy was evaluated against invasive FFR, when performed. Follow-up for nonfatal myocardial infarction and all-cause mortality was undertaken. The cost of an FFR-CT strategy was compared to alternative stress imaging pathways using cost analysis modeling.A total of 2,298 CCTAs from 12 centers underwent FFR-CT analysis. Stable chest pain was the main symptom in 77%, and 40% had equivocal stenosis. Positive and negative predictive values of FFR-CT were 49% and 76%, respectively. A total of 46 events (2%) occurred over a mean follow-up period of 17 months; FFR-CT (cutoff: 0.80) was not predictive. The FFR-CT strategy costs £2,102 per patient compared with an average of £1,411 for stress imaging.In clinical practice, the National Institute for Health and Care Excellence criteria for using FFR-CT were met in three-fourths of patients for symptoms and 40% for stenosis. FFR-CT had a low positive predictive value, making its use potentially more expensive than conventional stress imaging strategies.