RT Journal Article
SR Electronic
T1 NHS England-funded CT fractional flow reserve in the era of the ISCHEMIA trial
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 90
OP 95
DO 10.7861/clinmed.2020-0691
VO 21
IS 2
A1 Hazhee Rasoul
A1 Saad Fyyaz
A1 Daniela Noakes
A1 Carl Shakespeare
A1 Sarojini David
A1 Zeeshan M Khawaja
A1 Nikolaos Papamichail
A1 Khaled Alfakih
YR 2021
UL http://www.rcpjournals.org/content/21/2/90.abstract
AB 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.