• Int. J. Cardiol. · Mar 2015

    Comparative efficacy testing - fractional flow reserve by coronary computed tomography for the evaluation of patients with stable chest pain.

    • Ronak Rajani, Jessica Webb, Anna Marciniak, and Rebecca Preston.
    • Department of Cardiology, Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom; Department of Cardiac Computed Tomography, Guy's and St Thomas Hospital, SE1 7EH, United Kingdom. Electronic address: Dr.R.Rajani@gmail.com.
    • Int. J. Cardiol. 2015 Mar 15; 183: 173-7.

    BackgroundTo evaluate diagnostic strategies in a rapid access chest pain clinic (RACPC) in the United Kingdom and to predict the economical and clinical impacts of incorporating fractional flow reserve by coronary computed tomographic angiography (FFRCT) into future pathways.MethodsA retrospective analysis of consecutive patients referred to a RACPC in the United Kingdom. All patients had an evaluation of cardiovascular risk factors and symptoms from which the pre-test likelihood (PTL) of coronary artery disease (CAD) was evaluated using the Diamond Forrester (DF) criteria. All investigative strategies and their results were recorded. For the FFRCT economic evaluation of 1000 patients, standard National Health Service Tariffs were then applied and compared with a strategy that utilised FFRCT for varying PTL categories.ResultsThere were 410 patients with a median age of 57 (31-85) years. The DF criteria classified 39 (9.5%) patients as having a PTL of <10%, 76 (18.5%) 10-29% PTL, 117 (28.5%) 30-60% PTL, 114 (27.8%) 60-90% PTL and 64 (15.6%) >90% PTL. The concordance with the NICE recommended guidelines was <50% with the prevalence of obstructive CAD being <5% in patients with a PTL <90%. A model utilising FFRCT for patients with a PTL 10-90% predicted a 48% and 49% reduction in invasive angiography and percutaneous coronary intervention, a saving of £200 per patient and a reduction in relative adverse event rates of 4%.ConclusionsThe DF algorithm overestimates the PTL of CAD supporting an extended role for coronary CTA. Strategies incorporating FFRCT may confer benefits in evaluating patients with stable chest pain.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…