Coming out of this year’s American College of Cardiology (ACC) meeting, it’s clear that there is growing consensus for using coronary computed tomography angiography (CCTA) as a primary diagnostic strategy for assessing symptomatic patients with coronary artery disease (CAD). There were numerous discussions about whether the 2016 National Institute of Health and Care Excellence (NICE) guidelines putting CCTA as the first test for all stable chest pain patients should be universally adopted, following the recent publications by Hecht, et al in the European Heart Journal and Blaha, et al in the Journal of the American College of Cardiology (JACC). The discussions I engaged in certainly indicated there is no doubt the evidence supports putting CCTA as the frontline test for stable chest pain.
I was also encouraged to see that the CT manufacturers are offering new solutions such as CT scanners that are optimized for cardiac scanning and are compact enough to be housed in outpatient offices. These new offerings will help make CCTA more broadly available.
Specific to the HeartFlow FFRCT Analysis, I wanted to share two new presentations which demonstrate the value of following a CCTA and HeartFlow Analysis pathway.
ADVANCE Registry One-Year Outcomes (JACC Imaging publication)
ADVANCE is a large prospective international multicenter registry that included 5,083 patients at 38 sites, split between North America, the EU, and Japan. In the study, all patients underwent a CCTA. If additional information was needed, the physician ordered a HeartFlow Analysis. The 1-year results showed that the HeartFlow Analysis helped physicians more precisely stratify their patients and deliver more personalized care:
- Through 1-year follow-up, patients with a negative HeartFlow Analysis (FFRCT >0.80) were four fold less likely to experience MI or cardiovascular-related death than patients with a positive HeartFlow Analysis (FFRCT ≤0.80) (p=0.01).
- Two thirds of patient management plans were altered after physicians had access to the information from a HeartFlow Analysis.
- 97% of CCTAs submitted were accepted for a complete HeartFlow Analysis.
- Nearly three quarters of patients with a positive HeartFlow Analysis (FFRCT ≤0.80) who were sent for a diagnostic angiogram (ICA) underwent subsequent revascularization.
- An initial decision to manage patients with medical therapy alone based on a negative FFRCT was highly unlikely to be overturned over the ensuing year, meaning that there was durable, and safe, deferral of invasive testing in these patients.
FFRCT to Assess Coronary Artery Disease - Sanger Heart Experience
During the value-based healthcare session, Dr. Geoffrey Rose of the Sanger Heart & Vascular Institute presented the findings of incorporating the HeartFlow Analysis in their center. Sanger adopted the HeartFlow Analysis and found the following:
- Increased cath lab efficiency with more focus on interventions on known anatomy and less on making diagnosis
- Improved utilization of their imaging assets such as the CT scanner
- More informed recommendations for starting/ stopping/ advancing statin medications, providing a “precision” approach to preventive care
- Avoidance of further emergency room referrals and downstream testing for patients without CAD who continue to have symptoms.