Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial.

Publication ,  Journal Article
Curzen, N; Nicholas, Z; Stuart, B; Wilding, S; Hill, K; Shambrook, J; Eminton, Z; Ball, D; Barrett, C; Johnson, L; Nuttall, J; Fox, K ...
Published in: Eur Heart J
October 1, 2021

AIMS: Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. METHODS AND RESULTS: Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from -£112 (-8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). CONCLUSION: A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

October 1, 2021

Volume

42

Issue

37

Start / End Page

3844 / 3852

Location

England

Related Subject Headings

  • Quality of Life
  • Predictive Value of Tests
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Vessels
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Computed Tomography Angiography
  • Cardiovascular System & Hematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Curzen, N., Nicholas, Z., Stuart, B., Wilding, S., Hill, K., Shambrook, J., … Hlatky, M. (2021). Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J, 42(37), 3844–3852. https://doi.org/10.1093/eurheartj/ehab444
Curzen, Nick, Zoe Nicholas, Beth Stuart, Sam Wilding, Kayleigh Hill, James Shambrook, Zina Eminton, et al. “Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial.Eur Heart J 42, no. 37 (October 1, 2021): 3844–52. https://doi.org/10.1093/eurheartj/ehab444.
Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, et al. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J. 2021 Oct 1;42(37):3844–52.
Curzen, Nick, et al. “Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial.Eur Heart J, vol. 42, no. 37, Oct. 2021, pp. 3844–52. Pubmed, doi:10.1093/eurheartj/ehab444.
Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O’Kane P, Hobson A, Chauhan A, Uren N, Mccann G, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky M. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J. 2021 Oct 1;42(37):3844–3852.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

October 1, 2021

Volume

42

Issue

37

Start / End Page

3844 / 3852

Location

England

Related Subject Headings

  • Quality of Life
  • Predictive Value of Tests
  • Humans
  • Fractional Flow Reserve, Myocardial
  • Coronary Vessels
  • Coronary Stenosis
  • Coronary Artery Disease
  • Coronary Angiography
  • Computed Tomography Angiography
  • Cardiovascular System & Hematology