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Impact on stable chest pain pathways of CT fractional flow reserve

Lookup NU author(s): Rachel O'Leary, Dr Sam Urwin, Dr Andrew SimsORCiD, Dr Alan Bagnall



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objectives: To evaluate the impact of introducing CT fractional flow reserve (FFRCT) on stable chest pain pathways, concordance with National Institute for Health and Care Excellence (NICE) chest pain guidelines, resource usage and revascularisation of patients from a tertiary UK cardiac centre rapid access chest pain clinic (RACPC). Methods: Single-centre before and after study comparing data from electronic records and Strategic Tracing Service of all RACPC patients attending between 1 July 2017 and 31 December 2017, and 1 August 2018 and 31 January 2019. Results: Two hundred and sixty-eight and 287 patients (overall mean age 62 years, range 26-89 years, 48.3% male), were eligible for first-line CT coronary angiography (CTCA) pre-FFRCT and post-FFRCT, respectively. First-line CTCA use per NICE Guideline CG95 increased (50.6% pre-FFRCT vs 75.7% post-FFRCT, p<0.001). More patients reached pathway endpoint (revascularisation or assumed medical management) after one investigation (74.9% pre-FFRCT vs 84.9% post-FFRCT, p=0.005). There were fewer stress (22.8% pre-FFRCT vs 7.7% post-FFRCT, p<0.001) and rest (10.4% pre-FFRCT vs 4.2% post-FFRCT, p=0.007) myocardial perfusion scans and diagnostic-only angiograms (25.5% vs 13.7%, p<0.001). Despite fewer invasive procedures (29.3% pre-FFRCT vs 17.6% post-FFRCT, p=0.002), revascularisation rates remained similar (10.4% pre-FFRCT vs 8.8% post-FFRCT, p=0.561). Avoiding invasive investigations reduced inpatient admissions (39.0% pre-FFRCT vs 24.3% post-FFRCT, p<0.001). Time to revascularisation was unchanged (153.5 days pre-FFRCT vs 142.0 post-FFRCT, p=0.925). Unplanned hospital attendances, emergency admissions and adverse events were similar. Conclusions: FFRCT adoption was associated with greater compliance with NICE guidelines, reduced invasive diagnostic angiography, planned admissions and needing more than one test to reach a pathway endpoint.

Publication metadata

Author(s): O'Leary RA, Burn J, Urwin SG, Sims AJ, Beattie A, Bagnall A

Publication type: Article

Publication status: Published

Journal: Heart

Year: 2023

Pages: epub ahead of print

Online publication date: 20/04/2023

Acceptance date: 20/03/2023

Date deposited: 06/06/2023

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group


DOI: 10.1136/heartjnl-2022-321923

PubMed id: 37080766


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Funder referenceFunder name
Academic Health Science Network for the North East and North Cumbria