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Background Computed tomography-derived fractional flow reserve (FFRCT) and stress computed tomography perfusion (stress-CTP) are new techniques that combine anatomy and functional evaluation to improve assessment of coronary artery disease (CAD) using coronary computed tomography angiography (cCTA). Purpose This study sought to determine the effect of adding FFRCT and stress-CTP to cCTA alone for assessment of lesion severity and patient management of patients referred for chest pain. Methods 289 patients with stable chest pain scheduled for clinically indicated invasive coronary angiography (ICA) plus invasive FFR were evaluated with cCTA, FFRCT, and stress-CTP. Of 289 patients, 147 underwent static stress-CTP, while 142 were evaluated with dynamic stress-CTP. Management plan with optimal medical therapy (OMT) or percutaneous coronary intervention (PCI) for each patient according to results of each non-invasive technique was recorded, and then compared to what effectively applied according to results of reference standard technique (ICA + FFR). The primary endpoints for the study were the correct allocation of patients to OMT or PCI using cCTA, cCTA + FFRCT and cCTA + stress-CTP, and the correct assessment of non-invasive techniques for all three vessels in relation to angiographically and FFR-defined significance. Results Compared to cCTA alone, the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to OMT from 24% to 38% and 44%, respectively, while the addition of FFRCT and stress-CTP to cCTA alone increased the agreement in allocating patients to PCI from 29% to 32% and 36%, respectively. Using ICA + FFR as standard reference, cCTA showed agreement for all three vessels in 56% of patients, while combined approaches of cCTA + FFRCT and cCTA + stress-CTP showed agreement in 66% and 82% of patients, respectively. Conclusions The addition of functional assessment with FFRCT or Stress-CTP to cCTA has a substantial effect on the evaluation of the relevance of coronary artery disease and therefore on the management of patients compared to cCTA alone.

1173 Additional role of FFRct and stress CT perfusion in the management of patients with stable chest pain compared to cCTA alone