The Use and Efficacy of Fractional Flow Reserve-computed Tomography (FFR-CT): Real-World Multicenter Audit of Clinical Data With Cost Analysis
Authors' conclusion
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.
Study context
- Population
- Coronary CT angiograms submitted for FFR-CT analysis in clinical practice in EnglandCoronary computed tomographic angiograms (CCTAs) from 12 centres
- Participants
- 2,298 participants
- Comparison
- FFR-CT strategy vs alternative stress imaging pathways (cost); FFR-CT vs invasive FFR (diagnostic accuracy)
- Outcome
- Use of FFR-CT against NICE guidance (stable chest pain and equivocal stenosis 50%-69%), diagnostic accuracy vs invasive FFR, and cost
Methodological detailsdiagnostic accuracy and cost analysis, 12 centres
- Diagnostic accuracy and cost analysis
- 12 centres
Performance
As reported in the abstract
| Test or model | PPV | NPV |
|---|---|---|
| FFR-CT | 49% | 76% |
FFR-CT
PPV49%
NPV76%
- Stable chest pain as main symptom (NICE symptom criterion met)
- 77%
- Equivocal stenosis (50%-69%) (NICE stenosis criterion met)
- 40%
Further findings
| Outcome | FFR-CT | Stress imaging |
|---|---|---|
| Nonfatal MI and all-cause mortality · mean follow-up 17 months | 2% | — not stated in the abstract |
| Cost per patientCost analysis modeling | £2,102 per patient | average £1,411 per patient |
— not stated in the abstract
Nonfatal MI and all-cause mortality · mean follow-up 17 months
- FFR-CT (cutoff 0.80) was not predictive of events
Original publication
The Use and Efficacy of FFR-CT: Real-World Multicenter Audit of Clinical Data With Cost Analysis. JACC Cardiovasc Imaging. Published 12 April 2023. doi:10.
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