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dc.contributor.authorCurzen, N
dc.contributor.authorNicholas, Z
dc.contributor.authorStuart, B
dc.contributor.authorWilding, S
dc.contributor.authorHill, K
dc.contributor.authorShambrook, J
dc.contributor.authorEminton, Z
dc.contributor.authorBall, D
dc.contributor.authorBarrett, C
dc.contributor.authorJohnson, L
dc.contributor.authorNuttall, J
dc.contributor.authorFox, K
dc.contributor.authorConnolly, D
dc.contributor.authorO’Kane, P
dc.contributor.authorHobson, A
dc.contributor.authorChauhan, A
dc.contributor.authorUren, N
dc.contributor.authorMccann, G
dc.contributor.authorBerry, C
dc.contributor.authorCarter, J
dc.contributor.authorRoobottom, C
dc.contributor.authorMamas, M
dc.contributor.authorRajani, R
dc.contributor.authorFord, I
dc.contributor.authorDouglas, P
dc.contributor.authorHlatky, M

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims </jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results </jats:title> <jats:p>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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion </jats:title> <jats:p>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.</jats:p> </jats:sec>

dc.publisherEuropean Society of Cardiology
dc.subjectComputed tomography coronary angiography
dc.subjectCost analysis
dc.subjectFractional flow reserve (FFRCT)
dc.subjectRandomized controlled trial
dc.subjectStable angina
dc.subjectQuality of life
dc.titleFractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial
dc.typeJournal Article
dc.typeRandomized Controlled Trial
dc.typeResearch Support, Non-U.S. Gov't
plymouth.journalEuropean Heart Journal
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Faculty of Health/Peninsula Medical School
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/REF 2021 Researchers by UoA/UoA01 Clinical Medicine/UoA01 Clinical Medicine
plymouth.organisational-group/Plymouth/Users by role
plymouth.organisational-group/Plymouth/Users by role/Academics
dc.rights.embargoperiodNot known
rioxxterms.typeJournal Article/Review

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