title: 1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study.
abstract: Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFRCT) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown.
  
  
  
  The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFRCT instead of usual care.
  
  
  
  Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFRCT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL.
  
  
  
  Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFRCT cost weight of zero ($3,049 FFRCT vs. $2,579; p = 0.82), but were higher when using an FFRCT cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFRCT vs. 0.07 for usual care; p = 0.02).
  
  
  
  In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFRCT was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up. (The PLATFORM Study: Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts [PLATFORM]; NCT01943903).
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: pamela.douglas@duke.edu.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Cardiovascular Centre Aalst, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Byrne
authors.affiliation: University Hospital Southampton NHS Trust, Southampton, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Curzen
authors.affiliation: Freeman Hospital, Newcastle upon Tyne, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Purcell
authors.affiliation: University of Leipzig Heart Centre, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: Hospices Civils de Lyon and CARMEN INSERM 1060, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: Department of Cardiology, Johannes Gutenberg University Hospital, Mainz, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hink
authors.affiliation: LKH Graz West, Graz, Austria.
authors.forename: Herwig Walter
authors.initials: HW
authors.lastname: Schuchlenz
authors.affiliation: Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.affiliation: Department of Cardiology, Cavale Blanche Hospital, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Cardiovascular CT Unit, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jesper M
authors.initials: JM
authors.lastname: Jensen
authors.affiliation: Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Karen
authors.initials: K
authors.lastname: Chiswell
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Derek
authors.initials: D
authors.lastname: Cyr
authors.affiliation: HeartFlow, Redwood City, California.
authors.forename: Alan
authors.initials: A
authors.lastname: Wilk
authors.affiliation: HeartFlow, Redwood City, California.
authors.forename: Furong
authors.initials: F
authors.lastname: Wang
authors.affiliation: HeartFlow, Redwood City, California.
authors.forename: Campbell
authors.initials: C
authors.lastname: Rogers
authors.affiliation: Department of Health Research and Policy and Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
mesh_terms: D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors
keywords: economic outcomes; fractional flow reserve using computed tomography; major adverse cardiac events; quality of life