RSNA 2016

Abstract Archives of the RSNA, 2016


SSA04-04

Potential Impact of Noninvasive FFRct to Guide Therapy in Chest Pain Patients with Intermediate (50-70%) CTA Stenosis: Can It Reduce Cost, Risk and Radiation Exposure?

Sunday, Nov. 27 11:15AM - 11:25AM Room: S504AB



Kristof De Smet, MD, MSc, Brussels, Belgium (Abstract Co-Author) Nothing to Disclose
Jeroen Sonck, Brussels, Belgium (Abstract Co-Author) Nothing to Disclose
Dries Belsack, MD, Brussels, Belgium (Abstract Co-Author) Nothing to Disclose
Kaoru Tanaka, MD, PhD, Brussels, Belgium (Abstract Co-Author) Nothing to Disclose
Nico Buls, DSc, PhD, Jette, Belgium (Abstract Co-Author) Nothing to Disclose
Johan De Mey, Jette, Belgium (Presenter) Nothing to Disclose
PURPOSE

Can utilization of FFRct reduce cost, risk and radiation exposure in symptomatic patients with 50-70% CTA stenosis by reducing the number of “unnecessary” ICA-FFR examinations ?

METHOD AND MATERIALS

Retrospective analysis of 48 patients with stable chest pain, positive exercise ECG and intermediate (50-70%) CTA stenosis who were referred for ICA and FFR examination. Blinded FFRct analysis. Determination of diagnostic accuracy of FFRct vs CTA using FFR as reference standard. Evaluation of potential impact of clinical adoption of FFRct to guide clinical decision making; “unnecessary” ICA-FFR examinations defined as FFR in all vessels >0.80.

RESULTS

FFRct had higher diagnostic accuracy than CTA (83% vs 29%) with higher PPV (69% vs 29%) and a sixfold reduction in false positives. Using invasive FFR-guided therapy, 34/48 patients (71%) had nonobstructive CAD (FFR >0.80) and were treated medically; 14 (29%) had FFR ≤0.80 and were revascularized (8 PCI, 6 CABG).  There were no major adverse cardiac events. Use of a FFRct-guided strategy would have reduced “unnecessary” ICA-FFR procedures by 85%, thereby reducing the inherent risk of an invasive procedure. Assuming a cost of 1000€ per FFRct analysis, an overall cost reduction of 30% would have been achieved. Furthermore, radiation dose exposure would have been reduced by 63%, assuming an average dose of 2.1 mSv for CTA and 4.8 mSV for ICA.

CONCLUSION

Utilization of FFRct analysis in the evaluation of symptomatic patients with intermediate CTA stenosis  may result in fewer “unnecessary” invasive ICA-FFR examinations with reduced costs, risks and radiation dose exposure.

CLINICAL RELEVANCE/APPLICATION

Utilization of FFRct analysis in the evaluation of symptomatic patients with intermediate CTA stenosis may result in fewer “unnecessary” invasive ICA-FFR examinations with significantly reduced costs, risks and radiation dose exposure.