Pamela S. Douglas 1 , * , Gianluca Pontone 2 , Mark A. Hlatky 3 , Manesh R. Patel 1 , Bjarne L. Norgaard 4 , Robert A. Byrne 5 , Nick Curzen 6 , Ian Purcell 7 , Matthias Gutberlet 8 , Gilles Rioufol 9 , Ulrich Hink 10 , Herwig Walter Schuchlenz 11 , Gudrun Feuchtner 12 , Martine Gilard 13 , Daniele Andreini 2 , Jesper M. Jensen 4 , Martin Hadamitzky 5 , Karen Chiswell 1 , Derek Cyr 1 , Alan Wilk 14 , Furong Wang 14 , Campbell Rogers 14 , Bernard De Bruyne 15 †
Antonio Bartorelli (Collab), Daniele Andreini (Collab), Maurio Pepi (Collab), Erika Bertella (Collab), Saima Mushtaq (Collab), Virginia Beltrama (Collab), Andrea Baggiano (Collab), Sara Gaur (Collab), Lone Romby (Collab), Jette R Broderson (Collab), Lene Hjelm (Collab), Robert Byrne (Collab), Elena Guerra (Collab), Oliver Husser (Collab), Tobias Koppara (Collab), Jonathan Nadjiri (Collab), Martin Hadamitzky (Collab), Janina Winogradow (Collab), Janika Repp (Collab), Severin Weigand (Collab), Fritz Wimbaur (Collab), Raphazza Lohaus (Collab), Philipp Montz Rumpf (Collab), Elke Lorenz (Collab), Gisela Schoemig (Collab), Karin Hosl (Collab), Judith Ruf (Collab), Nick Curzen (Collab), James Shambrook (Collab), Simon Corbett (Collab), Iain Simpson (Collab), Alison Calver (Collab), James Wilkinson (Collab), Zoe Nicholas (Collab), Judith Ann Radmore (Collab), Bryony Tyrell (Collab), Claire Elridge (Collab), Rayner Lacoste (Collab), Ian Purcell (Collab), Rajiv Das (Collab), Iftikhar Haq (Collab), Azfar Ghaus Zaman (Collab), I Spyridopoulos (Collab), Alan Bagnall (Collab), J Ahmed (Collab), Alla Narytnyk (Collab), Jennifer Adams-Hall (Collab), Leslie Bremner (Collab), Susan Hetherington (Collab), Sarah Lamb (Collab), Angela Phillipson (Collab), Rebecca Wilson (Collab), Kathryn Procter (Collab), Samantha Jones (Collab), Victoria Andrianna Richardson (Collab), Louise Quinn (Collab), Vera Wealleans (Collab), Sarah Rowling (Collab), Chris Price (Collab), Matthias Gutberlet (Collab), Lukas Lehmkuhl (Collab), Michael Woinke (Collab), Gerhard Schuler (Collab), Daniel Urban (Collab), Christian Lücke (Collab), Fabian Juhrich (Collab), Kathrin Luderer (Collab), Jacqueline Fohlisch (Collab), Carola Dohnert (Collab), Gilles Rioufol (Collab), Gérard Finet (Collab), Philippe Douek (Collab), Yvonne Varillon (Collab), Delphine Laval (Collab), Adeline Mansuy (Collab), Pauline Renaudin (Collab), Muriel Rageade (Collab), Ulrich Hink (Collab), Karl Kreitner (Collab), Alexander Jabs (Collab), Yang Yang (Collab), Tommaso Gori (Collab), Bärbel Kaesberger (Collab), Herwig Schuchlenz (Collab), Dieter Botegal (Collab), Martin Genger (Collab), Peter Zechner (Collab), Wolfgang Weihs (Collab), Peter Kullnig (Collab), Walter Kau (Collab), Stefan Weikl (Collab), Gudrun Feuchtner (Collab), Guy Friedrich (Collab), Fabian Plank (Collab), Martine Gilard (Collab), Jacques Boschat (Collab), Philippe Castellant (Collab), Romain Didier (Collab), Françoise Martin (Collab), Pamela S. Douglas (Collab), Bernard De Bruyne (Collab), Mark Hlatky (Collab), B.L. Norgaard (Collab), Manesh Patel (Collab), Gianluca Pontone (Collab), Campbell Rogers (Collab), Manesh Patel (Collab), Manesh Patel (Collab), W. Schuyler Jones (Collab), Rohan Shah (Collab), Gary Dunn (Collab), Alicia Lowe (Collab), Beth Martinez (Collab), Auben Debus (Collab), Judi Jaeger (Collab), Furong Wang (Collab), Alan Wilk (Collab)
(Collab),01 September 2015
Angina, Coronary computed tomographic angiography, Fractional flow reserve, Non-invasive testing
In symptomatic patients with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) improves patient selection for invasive coronary angiography (ICA) compared with functional testing. The impact of measuring fractional flow reserve by CTA (FFR CT) is unknown.
At 11 sites, 584 patients with new onset chest pain were prospectively assigned to receive either usual testing ( n = 287) or CTA/FFR CT ( n = 297). Test interpretation and care decisions were made by the clinical care team. The primary endpoint was the percentage of those with planned ICA in whom no significant obstructive CAD (no stenosis ≥50% by core laboratory quantitative analysis or invasive FFR < 0.80) was found at ICA within 90 days. Secondary endpoints including death, myocardial infarction, and unplanned revascularization were independently and blindly adjudicated. Subjects averaged 61 ± 11 years of age, 40% were female, and the mean pre-test probability of obstructive CAD was 49 ± 17%. Among those with intended ICA (FFR CT-guided = 193; usual care = 187), no obstructive CAD was found at ICA in 24 (12%) in the CTA/FFR CT arm and 137 (73%) in the usual care arm (risk difference 61%, 95% confidence interval 53–69, P< 0.0001), with similar mean cumulative radiation exposure (9.9 vs. 9.4 mSv, P = 0.20). Invasive coronary angiography was cancelled in 61% after receiving CTA/FFR CT results. Among those with intended non-invasive testing, the rates of finding no obstructive CAD at ICA were 13% (CTA/FFR CT) and 6% (usual care; P = 0.95). Clinical event rates within 90 days were low in usual care and CTA/FFR CT arms.
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