COMPANY
HeartFlow
Healthcare technology company based in Redwood City, United States
Founded 2007Redwood City, United States
Using CTCA and FFR tools to improve stent placement decisions
Product: HeartFlow FFRCT Analysis Company: HeartFlow
Impact of an interactive CTCA/FFR interventional stent planning tool on patient management
The International Journal of Cardiovascular Imaging, 2025
Abstract
Fractional flow reserve (FFR) post percutaneous coronary intervention (PCI) is an important determinant of patient outcomes. A new virtual stent planning tool allows users to model PCI and obtain post PCI FFRCT.
We hypothesised that where a sub-optimal post PCI FFRCT was predicted theoretical management may be altered prior to invasive angiography. Single-centre retrospective review of patients listed for PCI with preceding CTCA(+ FFRCT), (Jan 2023-Sep 2024). Interventional cardiologists (ICs) at our institution determined a theoretical management strategy of (1) medical therapy (GDMT) (2) PCI or (3) multi-disciplinary team meeting (MDT) ± coronary artery bypass grafting (CABG) on a per-patient and per-vessel basis.
The virtual stent planning tool was then unblinded and decision making repeated. Changes to management were compared with Wilcoxon-signed rank test and inter-rater agreement with Fleiss’ free marginal kappa. 335 patients had a CTCA(+ FFRCT), 96 clinically listed for angiography, 74 included in the study. 73% male, 66 ± 11 years. On a per-patient basis using CTCA(+ FFRCT) data PCI was chosen in 95% of cases, GDMT in 4% and MDT ± CABG in 1%. The addition of the virtual planning tool changed management strategy to PCI in 59% of cases, GDMT in 30% and MDT in 11%, Wilcoxon-signed rank test P = 0.04.
In patients scheduled to undergo clinically indicated PCI with preceding CTCA(+ FFRCT) the use of the virtual stent planning tool significantly altered ICs theoretical management strategy upstream of invasive angiography, with a reduction in PCI, predominantly in favour of GDMT.