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175 CT fractional flow reserve: experiences from a district general hospital

Heart (British Cardiac Society), 2021-06, Vol.107 (Suppl 1), p.A135-A136 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;2021 Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2021-BCS.172

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  • Title:
    175 CT fractional flow reserve: experiences from a district general hospital
  • Author: Rasoul, Hazhee ; Fyyaz, Saad ; Noakes, Daniela ; Shakespeare, Carl ; David, Sarojini ; Khawaja, Zeeshan ; Papamichael, Nikolaos ; Al-Fakih, Khaled
  • Subjects: Cost control ; Patients ; Stents
  • Is Part Of: Heart (British Cardiac Society), 2021-06, Vol.107 (Suppl 1), p.A135-A136
  • Description: IntroductionThe UK National Institute for Health and Care Excellence recommended CT fractional flow reserve (CTFFR) to assess the functional significance of stenoses found on CT coronary angiogram (CTCA). NHS England subsequently negotiated a UK wide contract with HeartFlow, the provider of CTFFR, in 2018. We describe our experience in a district general hospital.MethodAll patients referred for CTFFR following CTCA between 1st January 2019 and 31st March 2020 were analysed. CTCA stenosis severity was categorised as mild (30-50%), moderate (50-70%) and severe (>70% or left main stem >50%). CTFFR <0.8 was deemed positive. Cost analysis was undertaken with the following tariffs: CTCA £220, CTFFR £530, invasive coronary angiogram (ICA) £1000, invasive FFR £336.Results140 patients were referred for CTFFR, with 15 (11%) rejected due to image quality (figure 1). 125 were analysed (80 male, mean age 59 yrs). 44 patients had mild stenosis on CTCA, 43 of which had negative CTFFR. 1 patient had positive CTFFR but did not attend follow up. 81 patients had moderate/severe stenosis on CTCA: 36 had positive CTFFR: 6 were medically managed, 29 underwent ICA, with 22 (76%) revascularised. 4 patients had false positive CTFFR and were medically managed after ICA. 6 had false negative CTFFR in one vessel, 5 of which had true positive and one had false positive in a different vessel.45 had negative CTFFR: 18 were medically managed, 14 underwent ICA. 4 (29%) were revascularised, with 3 noted to have calcium scores ranging 622-1108.Cost per patient in our cohort was £1166.51. If only patients with CTCA stenosis >50% underwent CTFFR the cost was £971.95.Abstract 175 Figure 1Downstream investigations and outcomes of patients following CTFFR analysis. CTFFR = CT Fractional Flow Reserve; CTCA = CT Coronary Angiogram; ICA = Invasive Coronary AngiogramConclusionCTFFR can be an effective gatekeeper to ICA with revascularisation rates of 76% in CTFFR <0.8 versus 29% with CTFFR >0.8. However, a high calcium score may influence CTFFR accuracy and further investigation is warranted in these patients. The use of CTFFR with mild CTCA stenosis did not influence management, with significant cost savings of £194.56 per patient had they not been referred for CTFFR.Conflict of InterestNone declared
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2021-BCS.172
  • Source: ProQuest Central
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