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PLATFORM: CTA with FFRCT linked to similar results, lower costs vs. usual care at 1 year
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Patient care steered by coronary CT angiography plus CT-based fractional flow reserve was linked to equivalent clinical outcomes and quality of life but lower costs vs. traditional care, according to 1-year data from the PLATFORM study.
Pamela S. Douglas, MD, from the Duke Clinical Research Institute, Duke University School of Medicine, and colleagues analyzed data from the PLATFORM study of outpatients with symptoms of chest pain aged at least 18 years (mean age, 61 years) without known CAD who displayed an intermediate penchant for obstructive CAD (20% to 80%; mean, 49%) and were candidates for non-emergent CV testing to find suspected CAD.
The patients were stratified by whether they received the usual-care testing, whether invasive or noninvasive, or whether they received CTA with selective use of CT-derived fractional flow reserve (FFRCT) via a central analysis (HeartFlow) instead of planned invasive or noninvasive testing.
Pamela S. Douglas
Among the cohort, 581 patients completed 1-year follow-up. The outcomes of interest were MACE, defined as death, MI and unplanned revascularization, total medical costs and quality of life.
Events rare
At 1 year, MACE events were infrequent. There was one periprocedural MI and one hospitalization for urgent revascularization in the FFRCT-guided group, and one unexplained death and one nonfatal MI in the usual-care group, Douglas and colleagues wrote, noting that the risk difference between the groups was near zero but noninferiority could not be determined due to low power.
“Importantly, there were no events during 1 year of follow-up in 117 patients whose planned [invasive coronary angiography] was canceled on the basis of CT/FFRCT findings, only four of whom underwent [invasive coronary angiography] during 1-year follow-up,” the researchers wrote.
Mean costs were lower with CTA and selective FFRCT ($8,127 vs. $12,145 usual care, P < .0001) in the patients with planned invasive testing.
In patients with planned noninvasive testing, there was no difference in mean costs when employing an FFRCT cost weight of zero (FFRCT, $3,049; usual care, $2,579; P = .82; difference, $471; 95% CI, –2,129 to 1,423). The mean costs were higher for FFRCT in this cohort when using an FFRCT cost weight equal to CTA ($3,223 vs. $2,579; P < .01).
Quality-of-life scores for both groups rose overall at 1 year (P < .001) with one exception: The planned noninvasive group as measured by the EuroQoL system (mean change for FFRCT, 0.12; mean change for usual care, 0.07; P = .02), according to the researchers.
Outcome studies needed
“For FFRCT to gain broader use, outcomes trials similar to the FAME trials should be performed to unequivocally demonstrate the central role this technology can play in managing patients with CAD,” René R. Sevag Packard, MD, from the division of cardiology, Ronald Reagan Medical Center; the department of molecular, cellular and integrative physiology; and the David Geffen School of Medicine, University of California, Los Angeles; and the Cardiovascular Research Foundation of Southern California, Los Angeles; and Ronald P. Karlsberg, MD, from UCLA’s Geffen School and the Cardiovascular Research Foundation of Southern California, as well as Cedars Sinai Heart Institute, wrote in an accompanying editorial.
“In the PLATFORM cases where invasive FFR was performed (50 vessels in 29 patients), FFRCT had an overall accuracy of 84%,” Packard and Karlsberg wrote. “An additional advantage of FFRCT is that it can be added on to coronary CTA for artery-specific physiological measurement when deemed necessary, with no need for repeat acquisition and, hence, no additional radiation or contrast administration.” – by James Clark
Disclosure: The PLATFORM study was funded by HeartFlow. Douglas reports receiving grants from HeartFlow during the study and previously reported support from GE Medical Systems. Please see the full study for a list of the other researchers’ relevant financial disclosures. Packard and Karlsberg report no relevant financial disclosures.
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