Imperial College London
Alternate

Emeritus ProfessorKimFox

Faculty of Medicine, National Heart & Lung Institute

Emeritus Professor
 
 
 
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Contact

 

+44 (0)20 7594 7966kim.fox

 
 
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Assistant

 

Ms Deborah Curcher +44 (0)20 7594 7966

 
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Location

 

Guy Scadding BuildingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Curzen:2021:eurheartj/ehab444,
author = {Curzen, N and Nicholas, Z and Stuart, B and Wilding, S and Hill, K and Shambrook, J and Eminton, Z and Ball, D and Barrett, C and Johnson, L and Nuttall, J and Fox, K and Connolly, D and O'Kane, P and Hobson, A and Chauhan, A and Uren, N and McCann, G and Berry, C and Carter, J and Roobottom, C and Mamas, M R R and Ford, I and Hlatky, MA},
doi = {eurheartj/ehab444},
journal = {European Heart Journal},
pages = {3844--3852},
title = {Fractional flow reserve derived from computed tomography coronary angiography in the assessment of stable chest pain. The FORECAST Randomised Trial},
url = {http://dx.doi.org/10.1093/eurheartj/ehab444},
volume = {42},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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.
AU  - Curzen,N
AU  - Nicholas,Z
AU  - Stuart,B
AU  - Wilding,S
AU  - Hill,K
AU  - Shambrook,J
AU  - Eminton,Z
AU  - Ball,D
AU  - Barrett,C
AU  - Johnson,L
AU  - Nuttall,J
AU  - Fox,K
AU  - Connolly,D
AU  - O'Kane,P
AU  - Hobson,A
AU  - Chauhan,A
AU  - Uren,N
AU  - McCann,G
AU  - Berry,C
AU  - Carter,J
AU  - Roobottom,C
AU  - Mamas,M R R
AU  - Ford,I
AU  - Hlatky,MA
DO  - eurheartj/ehab444
EP  - 3852
PY  - 2021///
SN  - 0195-668X
SP  - 3844
TI  - Fractional flow reserve derived from computed tomography coronary angiography in the assessment of stable chest pain. The FORECAST Randomised Trial
T2  - European Heart Journal
UR  - http://dx.doi.org/10.1093/eurheartj/ehab444
UR  - https://academic.oup.com/eurheartj/article/42/37/3844/6322392
UR  - http://hdl.handle.net/10044/1/90665
VL  - 42
ER  -
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