1-Year Outcomes of FFR<sub>CTsub>-Guided Care in Patients With Suspected Coronary Disease: The PLATFORM Study

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• 作者：Pamela S. Douglas ; MD<sup>asup><sup> ; sup><sup>pamela.douglas@duke.edu" class="auth_mail" title="E-mail the corresponding authorsup> ; Bernard De Bruyne ; MD<sup>bsup> ; Gianluca Pontone ; MD<sup>csup> ; Manesh R. Patel ; MD<sup>asup> ; Bjarne L. Norgaard ; MD<sup>dsup> ; Robert A. Byrne ; MB BCh<sup>esup> ; Nick Curzen ; BM<sup>fsup> ; Ian Purcell ; MD<sup>gsup> ; Matthias Gutberlet ; MD<sup>hsup> ; Gilles Rioufol ; MD<sup>isup> ; Ulrich Hink ; MD<sup>jsup> ; Herwig Walter Schuchlenz ; MD<sup>ksup> ; Gudrun Feuchtner ; MD<sup>lsup> ; Martine Gilard ; MD<sup>msup> ; Daniele Andreini ; MD<sup>csup> ; Jesper M. Jensen ; MD<sup>dsup> ; Martin Hadamitzky ; MD<sup>esup> ; Karen Chiswell ; PhD<sup>asup> ; Derek Cyr ; PhD<sup>asup> ; Alan Wilk ; BS<sup>nsup> ; Furong Wang ; MD<sup>nsup> ; Campbell Rogers ; MD<sup>nsup> ; Mark A. Hlatky ; MD<sup>osup> ; on behalf of the PLATFORM Investigators
• 关键词：economic outcomes ; fractional flow reserve using computed tomography ; major adverse cardiac events ; quality of life
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：2 August 2016
• 年：2016
• 卷：68
• 期：5
• 页码：435-445
• 全文大小：951 K

文摘

Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFR<sub>CTsub>) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown.

sSec_2">Objectives

spara0015">The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFR<sub>CTsub> instead of usual care.

sSec_3">Methods

spara0020">Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFR<sub>CTsub> (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) (death, myocardial infarction, unplanned revascularization), total medical costs, and QOL.

sSec_4">Results

spara0025">Patients averaged 61 years of age with a mean 49% pre-test probability of coronary artery disease. At 1 year, MACE events were infrequent, with 2 in each arm of the planned invasive group and 1 in the planned noninvasive cohort (usual care strategy). In the planned invasive stratum, mean costs were 33% lower with CTA and selective FFR<sub>CTsub> ($8,127 vs. $12,145 usual care; p < 0.0001); in the planned noninvasive stratum, mean costs did not differ when using an FFR<sub>CTsub> cost weight of zero ($3,049 FFR<sub>CTsub> vs. $2,579; p = 0.82), but were higher when using an FFR<sub>CTsub> cost weight equal to CTA. QOL scores improved overall at 1 year (p < 0.001), with similar improvements in both groups, apart from the 5-item EuroQOL scale scores in the noninvasive stratum (mean change of 0.12 for FFR<sub>CTsub> vs. 0.07 for usual care; p = 0.02).

sSec_5">Conclusions

spara0030">In patients with stable chest pain and planned invasive coronary angiography, care guided by CTA and selective FFR<sub>CTsub> was associated with equivalent clinical outcomes and QOL, and lower costs, compared with usual care over 1-year follow-up. (The PLATFORM Study: Prospective LongitudinAl Trial of FFRct: Outcome and Resource IMpacts [PLATFORM]; <span id="intref0010" class="interref" data-locatorType="https" data-locatorKey="//clinicaltrials.gov/ct2/show/NCT01943903">NCT01943903span>)