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Stress computed tomography perfusion (Stress-CTP) and computed tomography-derived fractional flow reserve (FFR CT ) are functional techniques that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD). This retrospective analysis from the PERFECTION study aims to assess the impact of their availability on the management of patients with suspected CAD scheduled for invasive coronary angiography (ICA) and invasive FFR. The management plan was defined as optimal medical therapy (OMT) or revascularization and was recorded for the following strategies: cCTA alone, cCTA+FFR CT , cCTA+Stress-CTP and cCTA+FFR CT +Stress-CTP. In 291 prospectively enrolled patients, cCTA+FFR CT , cCTA+Stress-CTP and cCTA+FFR CT +Stress-CTP showed a similar rate of reclassification of cCTA findings when FFR CT and Stress-CTP were added to cCTA. cCTA, cCTA+FFR CT , cCTA+Stress-CTP and cCTA+FFR CT +Stress-CTP showed a rate of agreement versus the final therapeutic decision of 63%, 71%, 89%, 84% (cCTA+Stress-CTP and cCTA+FFR CT +Stress-CTP vs cCTA and cCTA+FFR CT : p &lt; 0.01), respectively, and a rate of agreement in terms of the vessels to be revascularized of 57%, 64%, 74%, 71% (cCTA+Stress-CTP and cCTA+FFR CT +Stress-CTP vs cCTA and cCTA+FFR CT : p &lt; 0.01), respectively, with an effective radiation dose (ED) of 2.9 ± 1.3 mSv, 2.9 ± 1.3 mSv, 5.9 ± 2.7 mSv, and 3.1 ± 2.1 mSv. The addition of FFR CT and Stress-CTP improved therapeutic decision-making compared to cCTA alone, and a sequential strategy with cCTA+FFR CT +Stress-CTP represents the best compromise in terms of clinical impact and radiation exposure.

Sequential Strategy Including FFRCT Plus Stress-CTP Impacts on Management of Patients with Stable Chest Pain: The Stress-CTP RIPCORD Study