Open AccessProjected Costs and Consequences of Computed Tomography‐Determined Fractional Flow Reserve
Author(s) -
Hlatky Mark A.,
Saxena Akshay,
Koo BonKwon,
Erglis Andrejs,
Zarins Christopher K.,
Min James K.
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22205
Subject(s) - fractional flow reserve , medicine , conventional pci , coronary artery disease , percutaneous coronary intervention , radiology , cardiology , myocardial infarction , coronary angiography
Abstract Background Randomized trials have shown that fractional flow reserve ( FFR ) guided percutaneous coronary intervention ( PCI ) improves clinical outcome and reduces costs compared with visually guided PCI . FFR has been measured during invasive coronary angiography ( ICA ), but can now be derived noninvasively from coronary computed tomography ( CT ) angiography ( cCTA ) images ( FFR CT ). The potential value of FFR CT in clinical decision making is unknown. Hypothesis Use of FFR CT can reduce costs and improve outcomes among patients with suspected coronary artery disease. Methods We used clinical data from 96 patients in the DISCOVER‐FLOW (Diagnosis of Ischemia‐Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and outcomes data from the literature to project the initial management costs and 1‐year death/myocardial infarction rates associated with 5 clinical strategies: (1) ICA with PCI based on visual angiographic assessment, (2) ICA with FFR ICA ‐guided PCI , (3) cCTA followed by ICA and PCI based on visual assessment, (4) cCTA followed by ICA with FFR ICA ‐guided PCI , and (5) cCTA FFR CT and PCI of lesions with FFR CT ≤0.80. Results The projected initial management costs were highest for the ICA /visual strategy ($10 702), and lowest for the cCTA / FFR CT / ICA strategy ($7674). The use of FFR CT to select patients for ICA and PCI would result in 30% lower costs and 12% fewer events at 1 year compared with the most commonly used ICA /visual strategy. Conclusions A strategy of using FFR CT to guide the selection of patients for ICA and PCI might reduce costs and improve clinical outcomes in patients with suspected coronary artery disease.