Clinical and economic impact of FFR-CT�guided management in moderate coronary artery disease: an interventional simulation study

Evaluation of chest pain remains a frequent clinical challenge, with ongoing debate surrounding the optimal diagnostic strategy.Among the available modalities, coronary computed tomography angiography (CCTA) has emerged as a reliable diagnostic imaging modality because of its high sensitivity and negative predictive value.However, its positive predictive value remains moderate (60%-70%) vs invasive coronary angiography (ICA) and stress imaging modalities.This limitation often results in increased downstream testing, as demonstrated by the PROMISE trial. 1 Recent technological advancements have enabled non-invasive assessment of the hemodynamic significance of coronary lesions, allowing fractional flow reserve derived from computed tomography (FFR-CT) to be calculated directly from CCTA images without the need for pharmacological stress agents or additional radiation exposure.Previous prospective trials have demonstrated a significant enhancement in the diagnostic accuracy of FFR-CT vs CCTA alone.As a result, the United States, the United Kingdom and European clinical practice guidelines currently endorse the use of FFR-CT.However, uncertainties remain regarding its clinical effectiveness and cost-efficiency across different health care systems and clinical settings.We evaluated the potential clinical and economic impact of integrating FFR-CT into the routine practice in Spain vs standard care in patients with moderate stenosis on coronary computed tomography angiography (CCTA).We conducted a retrospective, observational, single-center intervention simulation study including outpatients with stable chest pain who underwent CCTA from July 2021 through December 2022 at a Spanish university hospital.Eligible patients had lesions classified as CAD-RADS 2.0 grade 3 (50%-69% stenosis) in vessels ≥ 1.5 mm, 2 body mass index (BMI < 35 kg/m 2 ) and coronary artery calcium score < 1000 Agatston Units (AU).Patients were identified through administrative databases, and electronic health records were reviewed to collect baseline clinical and imaging data.CCTA reports were independently reviewed by 5 clinical cardiologists, who recommended additional tests or treatments according to their clinical judgment.The same process was repeated after incorporation of FFR-CT to determine how functional information influenced decision-making.