FFR-CT may reduce downstream testing for chest pain

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Accounting for fractional flow reserve CT (FFR-CT) when evaluating the coronary CT angiography (CCTA) scans of patients with chest pain could improve patient classification and lower the rate of follow-up examinations, according to this study to be presented on Monday.

Clinicians are increasingly relying on Coronary Artery Disease Reporting and Data Systems (CAD-RADS) to decide whether emergency patients who present with acute chest pain might require additional testing beyond diagnostic CCTA, Dr. Simon Martin from the Medical University of South Carolina told AuntMinnie.com. FFR-CT analysis provides further support to that end, but the test is not currently included in CAD-RADS.

"The aim of this study was to investigate the impact of FFR-CT derived from CCTA on CAD-RADS stratifications in patients presenting with acute chest pain," he said.

Martin and colleagues examined the cases of 94 emergency patients with chest pain who underwent a CCTA exam at their institution, with subsequent FFR-CT analysis. They found that FFR-CT led to the reclassification of more than half of all patients initially categorized as CAD-RADS 3 (having moderate stenosis and requiring functional assessment) using CCTA alone. Several of the patients were reclassified as CAD-RADS 4 (having severe stenosis and requiring intervention), though most were reclassified as CAD-RADS 2 (having mild stenosis and not requiring further testing).

Overall, these changes may have decreased the rate of additional diagnostic testing in the patient cohort by roughly 45%.

"Adding FFR-CT analysis in these patients substantially decreases equivocality in CCTA interpretation, drastically reduces CAD-RADS 3 classifications, and has potential to obviate unnecessary downstream testing," Martin said. "One should consider an update to the CAD-RADS classification to account for the availability of FFR-CT."