Implementation of FFR-CT program at national level tied to improved outcomes at 2 years
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Key takeaways:
- Implementing a CT angiography-derived fractional flow reserve program improved certain outcomes in patients with chronic coronary syndrome at 2 years.
- Use of invasive coronary angiography was reduced.
Implementation of a CT angiography-derived fractional flow reserve program on a national level was associated with reduced risk for mortality and fewer downstream CV tests at 2 years, according to the results of the FISH&CHIPS study.
“FISH&CHIPS assessed at a national level the incremental impact of adding FFR-CT availability to a coronary CTA-first diagnostic paradigm for chronic coronary syndrome,” Tim Fairbairn, MBChB, PhD, FRCP, consultant cardiologist at Liverpool Heart and Chest Hospital and honorary senior lecturer at the University of Liverpool, U.K., said during a presentation at the European Society of Cardiology Congress.
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Fairbairn and colleagues conducted a real-world, retrospective, observational cohort study comparing patients who received coronary CTA before England’s National Health Service adopted FFR-CT with patients who received coronary CTA after the adoption.
The cohort included 90,553 patients (mean age, 59 years; 48% women) who underwent coronary CTA, of whom 54,865 had it after adoption of FFR-CT and the rest had it before the adoption. In the post-adoption period, FFR-CT was used 14.3% of the time, and in the two periods combined, it was used in 8.7% of cases.
At 2 years, compared with the pre-adoption group, the post-adoption group had an 8% decrease in mortality (HR = 0.923; 95% CI, 0.856-0.996; log-rank P = .039), a 14% decrease in CV mortality (HR = 0.863; 95% CI, 0.765-0.973; log-rank P = .01) and a 5% reduction in usage of invasive coronary angiography (HR = 0.95; 95% CI, 0.918-0.983; log-rank P = .004), Fairbairn said, noting there was no difference between the groups in MI (HR = 1.082; 95% CI, 0.959-1.22; log-rank P = .2), fatal MI (log-rank P = .1) or stroke (log-rank P = .7).
After adoption of FFR-CT, total revascularization rose 5% (log-rank P = .08), PCI rose 8% (log-rank P = .02) and CABG decreased by 5% (log-rank P = .5), he said.
The use of isolated invasive coronary angiography (not including revascularization) declined 13% after adoption (log-rank P < .001), Fairbairn said.
Medication use could have been a factor, he said, as rates of use increased during the post-adoption period for the following medical therapies: ACE inhibitors, antiplatelets, beta-blockers, calcium channel blockers and statins (P for all < .001).
Downstream CV tests excluding invasive coronary angiography declined by 12% in the post-adoption period (HR = 0.88; 95% CI, 0.844-0.916; P < .001), according to the researchers.
FFR levels predicted poor outcomes, as those with severely abnormal values (0.5 or less) had twice the risk for death (HR = 2; 95% CI, 1.29-3.11; P = .002) and three times the risk for CV death (HR = 3.14; 95% CI, 1.54-6.41; P = .002) and MI (HR = 3.43; 95% CI, 2.09-5.62; P < .001) compared with those with normal values, Fairbairn and colleagues found.
“Implementation of an FFR-CT program at a national level was associated at 2 years with reduced all-cause death, reduced cardiovascular death, no difference in MI events or MI death, reduced downstream cardiovascular tests including [invasive coronary angiography] and increased revascularization (PCI) and improved revascularization ratio,” Fairbairn said during the presentation.
In a press release from University Hospitals Harrington Heart & Vascular Institute, Daniel Simon, MD, president of academic and external affairs, chief scientific officer and Ernie and Patti Novak Distinguished Chair in Health Care Leadership at University Hospitals and professor of medicine and senior associate dean for academic affairs at Case Western Reserve University School of Medicine, whose team was the first in the U.S. to use FFR-CT in 2015, said the study shows FFR-CT “is a game changer.”
“This technology has changed our approach to the diagnosis of coronary artery disease,” Simon said in the release. We have embraced FFR-CT as the first-line, preferred test because it saves lives, reduces unnecessary invasive procedures and increases cardiac cath lab efficiency.”
References:
- New study confirms HeartFlow FFRct leads to improved patients outcomes. https://news.uhhospitals.org/news-releases/new-study-confirms-heartflow-ffrct-leads-to-improved-patient-outcomes.htm. Published Sept. 12, 2023. Accessed Sept. 15, 2023.
- Recent study from England’s National Health Service highlights positive impact of implementing HeartFlow’s FFRCT analysis for diagnosis of coronary artery disease. https://www.heartflow.com/newsroom/recent-study-from-englands-national-health-service-highlights-positive-impact-of-implementing-heartflows-ffrct-analysis-for-diagnosis-of-coronary-artery-disease. Published Aug. 26, 2023. Accessed Sept. 15, 2023.
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Fairbairn T, et al. Risk prediction on coronary artery disease using cardiac computed tomography. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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