TY - JOUR T1 - NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial JF - Clinical Medicine JO - Clin Med SP - 90 LP - 95 DO - 10.7861/clinmed.2020-0691 VL - 21 IS - 2 AU - Hazhee Rasoul AU - Saad Fyyaz AU - Daniela Noakes AU - Carl Shakespeare AU - Sarojini David AU - Zeeshan M Khawaja AU - Nikolaos Papamichail AU - Khaled Alfakih Y1 - 2021/03/01 UR - http://www.rcpjournals.org/content/21/2/90.abstract N2 - Background The National Institute for Health and Care Excellence (NICE) 2016 guidelines (CG95) recommend patients with new stable chest pain be investigated with computed tomography coronary angiography (CTCA). An updated guideline (MTG32) recommended using CT fractional flow reserve (CTFFR) as a gatekeeper to invasive coronary angiography (ICA) for patients with coronary stenosis on CTCA. Subsequently, NHS England negotiated a UK-wide contract with HeartFlow, the provider of CTFFR. We describe our experience with CTFFR and consider the impact of the recent ISCHEMIA trial on these guidelines.Methods We prospectively collected ICA and revascularisation data on all patients undergoing CTFFR from January 2019 to March 2020.Results One-hundred and twenty-five of 140 patients completed CTFFR analysis. Eighty-one patients had CTCA stenosis >50%. Thirty-six had positive CTFFR; 29 underwent ICA with 22 (75.9%) revascularised. Forty-five had negative CTFFR; 14 underwent ICA and four (28.6%) were revascularised. The average cost of investigation per patient (PP) was £971.95. Had these patients undergone ICA directly with no functional test after CTCA, the average cost would be £932.51 PP.Conclusion Our revascularisation rates suggest that CTFFR can potentially be a gatekeeper to ICA but does not necessarily yield cost savings. ER -