!
!
!
!
3"La
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2015" ischemica cronica oggi: cosa sta cambiando?
cardiopatia
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AULA!A!
15.00!)16.30!
!
La"Cardiopatia"ischemica"cronica"oggi":"cosa"sta"cambiando?"
Moderatori!:!Fiscella!Antonio!)!Gambino!Pietro!–!Mossuti!Ernesto!)!!Spicola!Luigi!
Discussant!:!Scordato!Francesca!)!Portale!Anna!!!!!
!!!!!!!!!
· I!percorsi!nel!postacuto:!Dalle!Linee!Guida!al!Documento!ANMCO/!GICR)IAPCR/GISE!!
Gabriele"Michele"
G. Di Guardo
· Le!metodiche!diagnostiche!non!invasive:!utilità!–!limiti!–!costi!
Cardiologia ARNAS Garibaldi-Nesima. Catania
Di"Guardo"Giuseppe"
Le metodiche diagnostiche non-invasive:
utilità – limiti – costi
2013 ESC guidelines on the management
of stable coronary artery disease
The Task Force on t he m anagem ent of st able coronar y ar t er y disease
of t he Eur opean Societ y of Car diology
ESC Com m it t ee for Pr act ice Guidelines (CPG): Jose Luis Zam or ano (Chair per son) (Spain), St ephan Achenbach
(Ger m any), Helm ut Baum gar t ner (Ger m any), Jer oen J. Bax (N et her lands), Héct or Bueno (Spain), Ver onica Dean
(Fr ance), Chr ist i Deat on (UK), Cet in Er ol (Tur key), Rober t Fagar d (Belgium ), Rober t o Fer r ar i (It aly), David Hasdai
(Isr ael ), Arno W . Hoes(N ether lands), PaulusKirchhof (Ger m any/UK), Juhani Knuut i (Finland), Philippe Kolh (Belgium),
Patr izio Lancellot t i (Belgium), AlesLinhart (Czech Republic), Pet rosN ihoyannopoulos(UK), Massimo F. Piepoli (It aly),
Piot r Ponikowski (Poland), Per Ant on Sir nes (N orway), Juan Luis Tam ar go (Spain), Michal Tendera (Poland),
Adam Torbicki (Poland), W illiam W ijns (Belgium), Stephan W indecker (Swit zerland).
Docum ent Reviewer s: Juhani Knuut i (CPG Review Coor dinat or ) (Finland), Mar co Valgim igli (Review Coor dinat or )
(It aly), Héct or Bueno (Spain), Mar c J. Claeys (Belgium ), N or ber t Donner -Banzhoff (Ger m any), Cet in Er ol (Tur key),
Her ber t Fr ank (Aust r ia), Chr ist ian Funck-Br ent ano (Fr ance), Oliver Gaem per li (Swit zer land),
José R. Gonzalez-Juanat ey (Spain), Michalis Ham ilos (Gr eece), David Hasdai (Isr ael ), St een Hust ed (Denm ar k),
St efan K. Jam es (Sweden), Kar i Ker vinen (Finland), Philippe Kolh (Belgium ), St een Dalby Kr ist ensen (Denm ar k),
Pat r izio Lancellot t i (Belgium ), Aldo Piet r o Maggioni (It aly), Massim o F. Piepoli (It aly), Axel R. Pr ies (Ger m any),
* Correspondingauthors. The two chairmen contributed equally to the documents. Chairman, France: Professor GillesMontalescot, Institut de Cardiologie, Pitie-Salpetriere University
Hospital, Bureau 2-236, 47-83 Boulevard de l’Hopital, 75013 Paris, France. Tel: + 33 1 42 16 30 06, Fax: + 33 1 42 16 29 31. Email: [email protected]. Chairman, Germany:
Professor Udo Sechtem, Abteilungfür Kardiologie, Robert Bosch Krankenhaus, Auerbachstr.110,DE-70376 Stuttgart,Germany.Tel: + 497118101 3456,Fax: + 497118101 3795,Email:
[email protected]
Entities having participated in the development of this document:
ESC Associations: Acute Cardiovascular Care Association (ACCA), European Association of Cardiovascular Imaging (EACVI), European Association for Cardiovascular Prevention &
Downloaded from by guest on June 30, 2015
Task For ce Mem ber s: Gilles Mont alescot * (Chair per son) (Fr ance), Udo Secht em *
(Chair per son) (Ger m any), St ephan Achenbach (Ger m any), Felicit a Andr eot t i (It aly),
Chr is Ar den (UK), Andr zej Budaj (Poland), Raffaele Bugiar dini (It aly), Filippo Cr ea
(It aly), Thom as Cuisset (Fr ance), Car lo Di Mar io (UK), J. Rafael Fer r eir a (Por t ugal ),
Ber nar d J. Ger sh (USA), Anselm K. Git t (Ger m any), Jean-Sebast ien Hulot (Fr ance),
N ikolaus Mar x (Ger m any), Lionel H. Opie (Sout h Afr ica), Mat t hias Pfist er er
(Swit zer land), Eva Pr escot t (Denm ar k), Fr ank Ruschit zka (Swit zer land), Manel Sabat é
(Spain), Roxy Senior (UK), David Paul Taggar t (UK), Er nst E. van der W all
(N et her lands), Chr ist iaan J.M. Vr int s (Belgium ).
Characteristics of tests commonly used to
diagnose the presence of CAD
Diagnosis of CAD
Sensitivity (%)
Specificity (%)
Exercise ECG
45-50
85-90
Exercise stress echocardiography
80-85
80-88
Exercise stress SPECT
73-92
63-87
Dobutamine stress echocardiography
79-83
82-86
Dobutamine stress MRI
79-88
81-91
Vasodilatator stress echocardiography
72-79
92-95
Vasodilatator stress SPECT
90-91
75-84
Vasodilatator stress MRI
67-94
61-85
Coronary CTA
95-99
64-83
Vasodilatator stress PET
81-97
74-91
Eur Heart J 2013; 34:2949-3003
Ruolo dei test non invasivi
• Chiarire la diagnosi
• Presenza di CAD
• Assenza di CAD
• Identificare i pazienti che beneficeranno
di un approccio invasivo
• Identificare i pazienti per i quali la CVG
rappresenta un rischio non necessario
Test non invasivi: un uso crescente
Ladapo JA et al Ann Intern Med. 2014 October 7; 161(7):482-490
Noninvasive testing was performed in 83.9% of the patients
At catheterization 149,739 patients (37.6%) had obstructive
coronary artery disease.
No coronary artery disease was reported in 39.2% of the patients
Utilità dei Test non invasivi
Patients with Obstructive Coronary Artery Disease, According to Noninvasive Test Result
Patel MR et al. N Engl J Med 2010: 362:886-895
Test non invasivi: un ruolo da ripensare
• L’imaging cardiaco è rimasto uno dei pochi settori
della cardiologia immune dalla tendenza di farsi
guidare dalla medicina basata sulla evidenza,
sottraendosi alla verifica dei suoi risultati in studi
prospettici e randomizzati
• Portandosi dietro, come corollario, una dilagante
inappropriatezza
nell’utilizzo delle metodiche
assieme ad una crescente preoccupazione sulla
lievitazione della spesa sanitaria
Gaibazzi N. G Ital Cardiol 2015; 16(9) 462-468
Evaluation of integrated Cardiac Imaging
for the Detection and Characterization of
Ischemic Heart Disease
E’ il primo studio che valuta simultaneamente, in
modo prospettico, in una singola popolazione, le
capacità diagnostiche di diverse modalità di imaging
(anatomiche e funzionali) nell’identificare pazienti
con CAD significativa alla CVG.
EVINCI
Evaluation of Integrated Cardiac Imaging for the Detection
and Characterization of Ischemic Heart Disease
EVINCI: Enrolment & investigation
EVINCI: Imaging Performance to Detect CAD
As a field, we must move beyond exclusively
examining the necessary, but insufficient, metric of
diagnostic accuracy and focus instead on the allimportant goal of using noninvasive testing to
improve patient outcomes.
PROMISE
Prospective Multicenter Imaging
Study for Evaluation of Chest Pain
• SCOPO
Comparare l’outcome di pz con sospetta CAD,
a seconda che ricevessero una valutazione
anatomica (CTA) o funzionale.
• IPOTESI
Migliore outcome con l’impiego di test anatomici
rispetto a quelli funzionali
Douglas PS et al N Engl J Med 2015;372:1291-300
PROMISE
Prospective Multicenter Imaging
Study for Evaluation of Chest Pain
• END POINT primario
• morte, IMA, ricovero per angina instabile
• complicazioni procedurali maggiori
• END POINT secondario
• lesioni non ostruttive alla CVG
• dose cumulativa di radiazioni
Douglas PS et al N Engl J Med 2015;372:1291-300
PROMISE study: flow-chart
Douglas PS et al N Engl J Med 2015;372:1291-300
PROMISE study: results
(3,3%)
3,0%
Douglas PS et al N Engl J Med 2015;372:1291-300
PROMISE study: risultati
12,2%
8,1%
Coronarografie, rivascolarizzazioni e outcome in base a test anatomico (CTA) vs funzionale
Gaibazzi N et al G Ital Cardiol 2015; 16(9) 462-468
PROMISE study: results
Douglas PS et al N Engl J Med 2015;372:1291-300
PROMISE: considerazioni economiche
Costo della CTA
$ 404
Costo test funzionali
Test ergometrico
ECO con test da sforzo
stress farmacologico
Test nucleare da sforzo
Test nucleare con farmaco
$ 174
$ 514
$ 501
$ 946
$ 1,132
Daniel B. Mark (Duke Clinical Research Center, Durham, NC)
Medscape Cardiology http://www.medscape.org/viewarticle/843977
PROMISE: considerazioni economiche
Nella gestione successiva agli esami, l'impiego
dei test funzionali si associa ad un costo
inferiore rispetto alla CTA, ma la differenza
non risulta statisticamente significativa
TEST
FUNZIONALI
< 279 $ a 3 mesi
< 358 $ a 12 mesi
< 388 $ a 2 anni
ANGIO-TAC
CORONARICA
Daniel B. Mark (Duke Clinical Research Center, Durham, NC)
Medscape Cardiology http://www.medscape.org/viewarticle/843977
Test non invasivi: costo/beneficio
• Mentre
le
valutazioni
cliniche
rimangono il criterio chiave per le
decisioni, c’è un crescente bisogno di
capire le implicazioni economiche di
tali decisioni
Expert Review of Pharmacoeconomics & Outcomes Research Do
For per
Cost per quality adjusted lif e years
The cost
cost–ef
–efffect
ectiveness
ivenessof
of
diagnost
diagnostic
ic cardiac
cardiac imaging
imaging
f or st
stable
able coronary
coronary art
artery
ery
disease
disease
Expert
Expert Rev.
Rev.Pharmacoecon.
Pharmacoecon.Outcomes
OutcomesRes.
Res.Early
Earlyonline,
online,1–9
1–9(2015)
(2015)
Cost per patient
Cost per correct diagnosis
Cost per life years gained
Current economic
evidence
incoronary
the
field
does
not
Early
artery
Early and
and accurate
accurate diagnosis
diagnosisofof stable
stablecoronary
arterydisease
disease(CAD)
(CAD)isiscrucial
crucialtotoreduce
reduce
morbidity,
morbidity, mortality
mortalityand
andhealthcare
healthcarecosts.
costs.This
Thiscritical
criticalappraisal
appraisalofofhealth-economic
health-economicliterature
literature
provide sufficient
information
to
guide
the
concerning
diagnostic
totosummarize
current
concerning non-invasive
non-invasive
diagnosticcardiac
cardiacimaging
imagingaims
aims
summarize
currentapproaches
approaches
to
to economic
economic evaluation
evaluation ofof diagnostic
diagnostic cardiac
cardiac imaging
imaging and
and associated
associatedprocedural
proceduralrisks,
risks,
inform
cardiologists
how
to
use
economic
analyses
for
decision-making,
highlight
areas
choice among
modalities
inform different
cardiologists how to use imaging
economic analyses for
decision-making, highlightor
areas
where
where new
new information
information could
could strengthen
strengthen the
the economic
economic evaluation
evaluationand
andshed
shedlight
lightonon
cost-effective
approaches
toto diagnose
cost-effective
approaches
diagnose stable
stable CAD.
CAD. Economic
Economic analysis
analysis can
can support
support
strategies for
each
patient.
cardiologists’
decision-making.
Current
economic
evidence
in
the
field
does
not
provide
cardiologists’ decision-making. Current economic evidence in the field does not provide
1
Giuseppe
Giuseppe Turchet
Turchettt i*
i* 1,,
2
M
MA
A Kroes
Kroes2,,
11
Valent
ina Lorenzoni
,,
Valentina
Lorenzoni
1
1
Leopoldo
Leopoldo Triest
Triestee ,, 3
3,
Ann-M
Ann-M arie
arie Chapman
Chapman
,
4
4,
Alison
C
Sw
eet
Alison C Sw eet4 ,
4 and
Geof
Geof ff II Wilson
Wilson5,6
and
5,6
Danilo
Danilo Neglia
Neglia
1
1Scuola Superiore Sant’Anna, Pisa, Italy
Scuola Superiore Sant’Anna, Pisa, Italy
2
2Abacus International, Bicester,
Abacus International, Bicester,
Oxfordshire, UK
Oxfordshire,
UK
3
3BresMed Health Solutions LTD, North
BresMed Health Solutions LTD, North
Church House, Sheffield, UK
Church House, Sheffield, UK
4
4GE Healthcare, Chalfont St. Giles,
GE Healthcare, Chalfont St. Giles,
Buckinghamshire, UK
Buckinghamshire, UK
5
5CNR Institute of Clinical Physiology,
CNR Institute of Clinical Physiology,
Pisa, Italy
Pisa,
Italy
6
6Fondazione Toscana G. Monasterio,
Fondazione Toscana G. Monasterio,
Pisa, Italy
Pisa, Italy
Cost per reclassification of r isk
Cost saving per year
sufficient
ororstrategies
forfor
sufficient information
informationto
toguide
guidethe
thechoice
choiceamong
amongdifferent
differentimaging
imagingmodalities
modalities
strategies
each
each patient.
patient. Available
Available economic
economic analyses
analysessuggest
suggest that
that computed
computedtomography
tomographycoronary
coronary0
2
angiography
(CTCA)
is
a
cost-effective
approach
to
rule
out
CAD
prior
to
invasive
coronary
angiography (CTCA) is a cost-effective approach to rule out CAD prior to invasive coronary
angiography
angiographyininpatients
patientswith
withlow
lowtotointermediate
intermediatepre-test
pre-testprobability
probabilityofofdisease
diseaseand
andthat
thatstress
stress
imaging
imagingmodalities
modalitiesmay
maybe
becost-effective
cost-effectiveatatvariable
variablepre-test
pre-testprobabilities.
probabilities.
Figure 2. Outcome measures reported i
KKEYWORDS
: coronary heart disease . diagnostic cardiac imaging . economic analysis . procedural risk . systematic
EYWORDS: coronary heart disease . diagnostic cardiac imaging . economic analysis . procedural risk . systematic
review
review
Coronary
Coronary artery
artery disease
disease (CAD)
(CAD) isisthe
thesingle
single
doi: 10.1586/14737167.2015.1051037
The
2013
The 2013European
EuropeanSociety
SocietyofofCardiology
Cardiology
SCOT-HEART
Scottish Computed Tomography of the HEART
End-point primario
la proporzione di pz
con diagnosi di angina a
6 settimane
Valutazione iniziale
36% diagnosi di angina
Risultati a 6 settimane
diagnosi di angina
modificata
nel 23% gruppo CTA
nell’1% gruppo S.C.
www.thelancet.com Vol 385 June 13, 2015
SCOT-HEART
Scottish Computed Tomography of the HEART
La CTA consentì la riclassificazione della diagnosi di angina in 1 ogni 4 pazienti ed
un consistente mutamento nelle successive indagini e nel trattamento terapeutico
www.thelancet.com Vol 385 June 13, 2015
SCOT-HEART
Scottish Computed Tomography of the HEART
La CTA consentì la riclassificazione della diagnosi di angina in 1 ogni 4 pazienti ed
un consistente mutamento nelle successive indagini e nel trattamento terapeutico
www.thelancet.com Vol 385 June 13, 2015
SCOT-HEART
Scottish Computed Tomography of the HEART
CTA
Riduzione del 38% eventi a F.U. di 1.7 anni
www.thelancet.com Vol 385 June 13, 2015
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
Un test in grado di fornire insieme dati anatomici
e funzionali (CTA/FFR) aumenta l’efficienza
diagnostica e la sicurezza per il paziente?
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
European Heart Journal Ad
European Heart Journal
doi:10.1093/eurheartj/ehv444
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
Riduzione
CVG del
61%
European Heart Journal Ad
European Heart Journal
doi:10.1093/eurheartj/ehv444
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
Una strategia CTA/FFR guidata
• rispetto ad un approccio direttamente invasivo
 riduce il numero delle CVG
 riduce la diagnosi di CAD non ostruttiva
 rende più efficiente il triage delle
rivascolarizzazioni
• non risulta più efficace dei test funzionali nel
ridurre le CAD non ostruttive alla CVG
European Heart Journal Ad
European Heart Journal
doi:10.1093/eurheartj/ehv444
Conclusioni
• I test non invasivi lasciano finalmente le aride
tabelle di sensibilità e specificità ed affrontano il
mare aperto degli studi clinici randomizzati
• I risultati di trial clinici recenti confermano tuttavia
le indicazioni delle attuali linee-guida sulla gestione
del dolore toracico stabile
• I test funzionali non perdono, a confronto con le più
recenti metodiche anatomiche, la loro tradizionale
utilità nella stratificazione dei pazienti
Conclusioni
• Una strategia combinata di test anatomici e
funzionali può migliorare il rapporto fra costo e
beneficio sia per il paziente che per la società
Conclusioni
Ulteriori
cliniche,
osservazioni
outcome-
oriented, sono tuttavia
necessarie per un più
appropriato uso delle
tecnologie
e
delle
risorse economiche
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
European Heart Jour
European Heart Journal
doi:10.1093/eurheartj/ehv444
SCOT-HEART
Scottish Computed Tomography of the HEART
Conclusioni
in pz con sospetta angina, l’aggiunta della CTA
• chiarisce la diagnosi
• riduce il bisogno di ulteriori test
• incrementa il ricorso alla CVG (ed alla
rivascolarizzazione)
• può ridurre il rischio di infarto miocardico
www.thelancet.com Vol 385 June 13, 2015
SCOT-HEART
Scottish Computed Tomography of the HEART
CTA
Incremento rivascolarizzazioni a F.U. di 1.7 anni (p=0.0611)
www.thelancet.com Vol 385 June 13, 2015
Expert Review of Pharmacoeconomics & Outcomes Research Do
For per
Cost per quality adjusted lif e years
The cost
cost–ef
–efffect
ectiveness
ivenessof
of
diagnost
diagnostic
ic cardiac
cardiac imaging
imaging
f or st
stable
able coronary
coronary art
artery
ery
disease
disease
Expert
Expert Rev.
Rev.Pharmacoecon.
Pharmacoecon.Outcomes
OutcomesRes.
Res.Early
Earlyonline,
online,1–9
1–9(2015)
(2015)
1
Giuseppe
Giuseppe Turchet
Turchettt i*
i* 1,,
2
M
MA
A Kroes
Kroes2,,
11
Valent
ina Lorenzoni
,,
Valentina
Lorenzoni
1
1
Leopoldo
Leopoldo Triest
Triestee ,, 3
3,
Ann-M
Ann-M arie
arie Chapman
Chapman
,
4
4,
Alison
C
Sw
eet
Alison C Sw eet4 ,
4 and
Geof
Geof ff II Wilson
Wilson5,6
and
5,6
Danilo
Danilo Neglia
Neglia
1
1Scuola Superiore Sant’Anna, Pisa, Italy
Scuola Superiore Sant’Anna, Pisa, Italy
2
2Abacus International, Bicester,
Abacus International, Bicester,
Oxfordshire, UK
Oxfordshire,
UK
3
3BresMed Health Solutions LTD, North
BresMed Health Solutions LTD, North
Church House, Sheffield, UK
Church House, Sheffield, UK
4
4GE Healthcare, Chalfont St. Giles,
GE Healthcare, Chalfont St. Giles,
Buckinghamshire, UK
Buckinghamshire, UK
5
5CNR Institute of Clinical Physiology,
CNR Institute of Clinical Physiology,
Pisa, Italy
Pisa,
Italy
6
6Fondazione Toscana G. Monasterio,
Fondazione Toscana G. Monasterio,
Pisa, Italy
Pisa, Italy
Cost per patient
Cost per correct diagnosis
Cost per life years gained
Early
Early and
and accurate
accurate diagnosis
diagnosisofof stable
stablecoronary
coronaryartery
arterydisease
disease(CAD)
(CAD)isiscrucial
crucialtotoreduce
reduce
morbidity,
morbidity, mortality
mortalityand
andhealthcare
healthcarecosts.
costs.This
Thiscritical
criticalappraisal
appraisalofofhealth-economic
health-economicliterature
literature
Cost percurrent
reclassification
of r isk
concerning
concerning non-invasive
non-invasive diagnostic
diagnosticcardiac
cardiacimaging
imagingaims
aimstotosummarize
summarize
currentapproaches
approaches
to
to economic
economic evaluation
evaluation ofof diagnostic
diagnostic cardiac
cardiac imaging
imaging and
and associated
associatedprocedural
proceduralrisks,
risks,
inform
cardiologists
how
to
use
economic
analyses
for
decision-making,
highlight
areas
inform cardiologists how to use economic analyses for decision-making, highlight areas
where
where new
new information
information could
could strengthen
strengthen the
the economic
economic evaluation
evaluationand
andshed
shedlight
lightonon
cost-effective
can
cost-effective approaches
approaches toto diagnose
diagnose stable
stable CAD.
CAD. Economic
Economic analysis
analysis
can support
support
Cost
saving
per
year
cardiologists’
decision-making.
Current
economic
evidence
in
the
field
does
not
provide
cardiologists’ decision-making. Current economic evidence in the field does not provide
sufficient
ororstrategies
forfor
sufficient information
informationto
toguide
guidethe
thechoice
choiceamong
amongdifferent
differentimaging
imagingmodalities
modalities
strategies
each
each patient.
patient. Available
Available economic
economic analyses
analysessuggest
suggest that
that computed
computedtomography
tomographycoronary
coronary0
2
angiography
(CTCA)
is
a
cost-effective
approach
to
rule
out
CAD
prior
to
invasive
coronary
angiography (CTCA) is a cost-effective approach to rule out CAD prior to invasive coronary
angiography
angiographyininpatients
patientswith
withlow
lowtotointermediate
intermediatepre-test
pre-testprobability
probabilityofofdisease
diseaseand
andthat
thatstress
stress
imaging
imagingmodalities
modalitiesmay
maybe
becost-effective
cost-effectiveatatvariable
variablepre-test
pre-testprobabilities.
probabilities.
Figure 2. Outcome measures reported i
KKEYWORDS
: coronary heart disease . diagnostic cardiac imaging . economic analysis . procedural risk . systematic
EYWORDS: coronary heart disease . diagnostic cardiac imaging . economic analysis . procedural risk . systematic
review
review
Coronary
Coronary artery
artery disease
disease (CAD)
(CAD) isisthe
thesingle
single
doi: 10.1586/14737167.2015.1051037
The
2013
The 2013European
EuropeanSociety
SocietyofofCardiology
Cardiology
EVINCI study: considerazioni
• Riconoscere una CAD ostruttiva con CTA è più utile
che identificare o escludere una stenosi
funzionalmente significativa con stress-imaging ?
• La stenosi angiografica come gold standard deve
essere considerato un parametro imperfetto, in
assenza di documentate alterazioni funzionali.
• Se l'end-point fosse stato la rivascolarizzazione i
risultati sarebbero stati identici nei due gruppi
(54% con CTA e del 50% con WMI)
PROMISE: considerazioni economiche
" On the whole, CTA might not be the holy grail it was
once hoped to be - that being the complete solution
for diagnostic testing - but its more liberal use
following the PROMISE standards will definitely
improve some aspects of care without causing the
economic Armageddon in the healthcare system."
Daniel B. Mark (Duke Clinical Research Center, Durham, NC)
Medscape Cardiology http://www.medscape.org/viewarticle/843977
A total of 398,978 patients were included in the study.
Noninvasive testing was performed in 83.9% of the patients
At catheterization 149,739 patients (37.6%) had obstructive
coronary artery disease.
No coronary artery disease was reported in 39.2% of the patients
PLATFORM
study
Prospective Longitudinal Trial of FFRCT
Outcomes and Resource Impacts
End-Point primario
• Confronto CAD non ostruttiva fra
gruppo CVG programmata/gruppo FFRCT
End-Point secondario
• Confronto CAD non ostruttiva fra
gruppo test non invasivi/gruppo FFRCT
MACE ed esposizione radiologica a 90 giorni
European Heart Journal Ad
European Heart Journal
doi:10.1093/eurheartj/ehv444