CT FFR in stable heart disease and Coronary Computed Tomographic Angiography helps improve patient care and societal costs
CT FFR in stable heart disease and Coronary Computed Tomographic Angiography helps improve patient care and societal costs
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稳定性心脏病中的 CT FFR 和冠状动脉计算机断层扫描血管造影有助于改善患者护理和社会成本
DOI：
10.1093/eurheartj/ehad655.161
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发表时间：
2023
影响因子：
39.3
通讯作者：
Fairbairn T
中科院分区：
文献类型：
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作者：
Fairbairn T
自2016年NICE指南以来，NHS England(NHSE)一直倡导将冠状动脉CT血管造影(CCTA)作为可疑症状性冠状动脉疾病(CAD)的一线诊断测试，并自2017年以来将CT部分血流储备(CT FFR)作为二线测试。2018年，一项国家卫生技术计划资助了CT FFR的使用，目的是改善患者路径并降低成本。目的确定一项新技术(CT FFR)引入国家卫生系统是否改善了患者的护理。方法一项多中心、观察性分析队列研究，对25个NHSE地点接受CCTA的所有患者进行为期3年(2017年4月至2020年3月)的冠心病评估。网站和患者被归类为CT、FFR健康技术引进前或后。结果90,573例患者(年龄58.1±13.2岁，51.9%男性，48.1%女性)接受了CCTA和8831个CT FFR的二线检查。结果显示，CT后FFR的优势比(95%CI)在全因死亡率(n=1135(3.2%)vs1627(3.0%)；OR0.93(0.86，1.01)，p=0.07)或心肌梗死事件(n=348(1.0%)vs597(1.1%)；OR1.12(0.98，1.28)，p=0.10)方面没有差异。接受经皮冠状动脉介入治疗(PCI)的患者心血管死亡率较低(n=466(1.3%)vs 628(1.1%)；OR 0.88(0.78，0.99)，p=0.03)(n=1866(5.2%)vs 3069(5.6%)；OR 1.07(1.01，1.14)，p=0.02，但不包括CABG(n=669(1.9%)vs 993(1.8%)；OR 0.97(0.87，1.07)，p=0.48)。图2：CT-FFR术后进行的心脏下游检查较少(n=6,356(17.8%)vs 8,073(14.7%)，p<；0.001)，包括较少的有创冠状动脉造影术(n=4,128(11.6%)vs 5,437(9.9%)；OR 0.84(0.81，0.88)，p<；0.001)。冠状动脉搭桥术的发生率有相关的增加，但冠脉搭桥术的发生率没有增加。全因死亡率没有随时间的变化而变化，但CT治疗后2年的FFR人群的心血管死亡率明显较低。
BackgroundNHS England (NHSE) has advocated Coronary Computed Tomographic Angiography (CCTA) as the first line diagnostic test for suspected symptomatic coronary artery disease (CAD) since NICE Guidance in 2016 and CT Fractional Flow Reserve (CT FFR) as a second line test since 2017. In 2018 a national health technology programme funded CT FFR utilisation with the aim of improving patient pathways and reducing costs.PurposeTo determine whether the introduction of a new technology (CT FFR) into the national health system improved patient care.MethodsA multi-centre, observational analytic cohort study of all patients that underwent CCTA at 25 NHSE sites for the assessment of CAD over a 3-year period (April 2017- March 2020). Sites and patients were categorised as pre or post CT FFR health technology introduction. Clinical outcomes (all-cause death, myocardial infarction, cardiovascular death, revascularization) and resource utilization (downstream cardiac tests) were assessed at 2 years from NHS digital health records.Results90,573 patients (Age 58.1±13.2, 51.9% male, 48.1% female), received 96,353 CCTA and 8,831 CT FFR as a second line test. Clinical characteristics were well matched between the 2 study groups (Figure 1).Results are presented as pre-CT FFR vs post-CT FFR with Odds Ratio (95% CI) for Post-CT FFR.No difference was observed for all-cause mortality (n=1135 (3.2%) vs 1627 (3.0%); OR 0.93 (0.86, 1.01), p=0.07) or Myocardial infarction events (n=348 (1.0%) vs 597 (1.1%); OR 1.12 (0.98, 1.28), p=0.10). Cardiovascular mortality was lower in the post CT FFR population (n=466 (1.3%) vs 628 (1.1%); OR 0.88 (0.78, 0.99), p=0.03) with higher rates of percutaneous intervention (PCI) (n=1866 (5.2%) vs 3069 (5.6%); OR 1.07 (1.01, 1.14), p=0.02 but not CABG (n=669 (1.9%) vs 993 (1.8%); OR 0.97 (0.87, 1.07), p=0.48). Figure 2. Fewer cardiac downstream tests were performed post CT-FFR (n=6356 (17.8%) vs 8073 (14.7%), p<0.001) including fewer invasive coronary angiograms (ICA) (n=4128 (11.6%) vs 5437 (9.9%); OR 0.84 (0.81, 0.88), p<0.001).ConclusionThe introduction of CT FFR as a new technology on a national scale as part of a health intervention programme resulted in fewer cardiac downstream tests including fewer ICA. There was an associated increase in PCI but not CABG rates. All-cause mortality rates did not differ over time but CV mortality was significantly lower in the post-CT FFR population at 2 years.