Field-training reference. Numbers come from the cited studies and carry their designs' limits (see each Evidence Matrix pop-out). Illustrative figures are labeled as such, and items marked Unverified need confirmation before any external use.
In the Los Angeles market, where much managed-care cardiology runs through delegated-risk medical groups/IPAs, Medicare Advantage plans and Medi-Cal managed care (see the SoCal tab), cardiovascular service lines face a paradox: anatomical CCTA reveals plaque and stenosis, but stenosis severity does not always match flow limitation (in the Western Denmark cohort, 61% of patients with intermediate CCTA stenosis had FFRCT >0.80). Without physiology, some patients go on to invasive angiography that finds no obstructive disease (only 37.6% of elective caths in patients without known CAD showed obstructive CAD in NCDR data from 2004–2008; Patel, NEJM 2010). HeartFlow FFRCT adds a physiology estimate from the same CCTA to support decisions about who needs the cath lab, and Plaque Analysis adds plaque quantification (an evolving evidence base). Observational data show low 1-year event rates when FFRCT is >0.80 (see Evidence Matrix), which can help free cath-lab time for higher-acuity cases. In the Danish ADVANCE-DK follow-up, death or MI was lower with a normal than an abnormal FFRCT at 3 and 7 years (observational; the endpoints differ: all-cause death or nonfatal MI at 3 years, cardiovascular death or spontaneous MI at 7 years).
The Executive Translation Layer: Bridging Research Endpoints to Commercial Sales Talk Tracks
Clinical Research Result → Field Commercial PitchWestern Denmark Cohort (Nørgaard, JACC 2018)
What It Showed: In 3,674 consecutive CCTA patients, the 677 with intermediate stenosis received FFRCT. Over a median 24 months, events were 3.9% with FFRCT >0.80 managed medically vs 2.8% with CCTA stenosis <30% (p=0.58). Observational; not powered to prove equivalence. The Danish ADVANCE-DK registry reports 3- and 7-year outcomes by FFRCT result (see Evidence Matrix).
TAM Talk Track: "Chief, in a consecutive real-world Danish cohort, patients with an FFRCT above 0.80 who were managed medically had a 3.9% event rate over two years, close to the 2.8% in patients with minimal disease on CCTA. It is observational, but it is the kind of real-world signal that supports a deferral conversation."
~60% of Planned ICAs Cancelled (PLATFORM)
What It Showed: In patients already scheduled for invasive angiography, a CTA/FFRCT-first pathway cancelled the procedure in about 60% (61% in the 2015 report), and no obstructive CAD at cath was 12% vs 73% with usual care. Sequential non-randomized cohorts, small study; no events at 1 year in the 117 patients whose ICA was cancelled (not powered for noninferiority).
TAM Talk Track: "To the Cath Lab Director: we are not trying to take your cases; we are trying to keep your schedule for the patients who need the lab. In PLATFORM, far fewer caths found no obstructive disease in the FFRCT-guided cohort (12% vs 73%). Let's see what your local number is."
83% Per-Vessel Accuracy in the Most Calcified Vessels (NXT Substudy)
What It Showed: In the NXT calcification substudy, FFRCT was right 83% of the time per vessel in the highest vessel-calcium quartile (74% per patient at Agatston 416–3,599), with a non-significant trend to lower accuracy as calcium rises. Separately, in ADVANCE-DK patients with calcium ≥400, death or MI was 2.2% (3 years; all-cause death or nonfatal MI) and 8.2% (7 years; cardiovascular death or spontaneous MI) with a normal FFRCT vs 9.0% and 13.2% with an abnormal one (prognosis, not diagnostic accuracy; the endpoints differ).
TAM Talk Track: "To Interventionalists/Radiologists: calcium can limit CCTA reads. In the NXT calcification substudy, FFRCT kept 83% per-vessel accuracy in the most calcified vessels, though performance trends lower with heavy calcium, so case selection and image quality still matter."
−$3,391 Mean 90-Day Cost (PLATFORM, Planned-Invasive Stratum)
What It Showed: In PLATFORM's planned-invasive stratum, mean 90-day total medical cost was $7,343 (CTA/FFRCT-guided) vs $10,734 (usual care), a $3,391 difference (95% CI $1,186–$5,595). Non-randomized cohorts; costs used 2015 Medicare fee-schedule weights with FFRCT priced at $0 in the base case.
TAM Talk Track: "To IPA / health-plan medical directors: in PLATFORM, 90-day medical cost was lower in the FFRCT-guided planned-cath group. Let's rerun that with your own allowed amount per diagnostic cath and see whether it moves your pool."
36% Management-Plan Change (RIPCORD)
What It Showed: In 200 NXT cases re-planned by three interventional cardiologists by consensus, the management category changed in 36% (72/200) once FFRCT was added to CTA, and 30% of CTA-alone PCI plans moved to medical therapy. These are simulated plans, not patient outcomes.
TAM Talk Track: "To General Cardiologists: anatomy and physiology do not always agree. In RIPCORD, adding FFRCT changed the consensus plan in about one in three cases. It is decision support for you and your team, not a replacement for clinical judgment."
CHD Death/Nonfatal MI 2.3% vs 3.9% (SCOT-HEART, HR 0.59)
What It Showed: Adding CCTA to standard care in stable chest pain was followed by fewer CHD deaths or nonfatal MIs at 5 years (2.3% vs 3.9%, HR 0.59), with more preventive therapy started. A separate post hoc analysis found low-attenuation plaque burden >4% carried HR 4.65 for MI. SCOT-HEART is a CCTA-pathway trial, not a HeartFlow trial.
TAM Talk Track: "CCTA can show non-obstructive plaque that stress testing is not designed to see. In SCOT-HEART, adding CCTA to standard care was followed by fewer coronary deaths or heart attacks over five years alongside more preventive therapy. That is the CCTA pathway, not a claim about any one software."
If You Remember Only Six Things (The Commercial Core Pillars)
1. Guideline Support: The 2021 ACC/AHA chest pain guideline gives CCTA a Class 1 (LOE A) recommendation in intermediate-high risk stable chest pain with no known CAD, and FFR-CT a Class 2a (LOE B-NR) recommendation for 40–90% proximal/mid stenoses on CCTA. Stress imaging is also a Class 1 option.
2. Real-World Signal (Western Denmark): In a consecutive Danish cohort, events were 3.9% over a median 24 months with FFRCT >0.80 managed medically vs 2.8% with minimal CCTA disease (observational).
3. Hemodynamic Accuracy: In the PACIFIC FFRCT substudy (post hoc, single centre), per-vessel AUC was 0.94 vs invasive FFR, compared with 0.83 CCTA, 0.87 PET and 0.70 SPECT; per patient, FFRCT and PET were comparable (0.92 vs 0.91).
4. Cath Lab Yield: In PLATFORM (non-randomized, small), no obstructive CAD at cath was 12% with a CTA/FFRCT-guided pathway vs 73% with usual care, and about 60% of planned ICAs were cancelled.
5. Low Event Rate After a Negative FFRCT: In the ADVANCE registry, 12 of 1,592 patients with FFRCT >0.80 had a MACE at 1 year (about 0.75%, calculated from the printed counts). In its Danish sites (ADVANCE-DK), death or heart attack occurred in 2.1% at 3 years (all-cause death or nonfatal MI) and 5.7% at 7 years (cardiovascular death or spontaneous MI) with a normal FFRCT vs 6.6% and 12.5% with an abnormal one; the endpoints differ. Observational; a supporting data point, not proof that deferral is safe.
6. VBC Conversation: In PLATFORM's planned-invasive stratum, mean 90-day cost was $3,391 lower with the FFRCT-guided pathway (non-randomized, Medicare-weighted). Rerun it with the account's own numbers.
Physician & Operational Stakeholder Alignment Framework
Select Persona to View Tailored Commercial Talk TracksFocused on clinic scheduling, prior-authorization approval friction, provider productivity, and minimizing patient leakage to competing health systems.
- Single diagnostic pathway: FFRCT is computed from the CCTA already acquired, so it does not need a separate stress test or second scan. Whether this shortens a practice's workup needs local measurement.
- 66.9% management-plan change (ADVANCE): in the registry, core-lab plans changed in 66.9% of patients once FFRCT was added to CCTA, in both directions; a decision metric, not proof of better outcomes.
- Patient experience: avoiding an invasive angiogram avoids its procedural risk. DISCHARGE found major procedure-related complications of 0.5% with CT first vs 1.9% with ICA first (no FFRCT).
Ask how long a chest-pain workup takes in the practice today and where patients drop out; long workups can push patients to other systems.
"Administrator, how much staff time goes to prior authorizations for stress tests that end in a cath referral anyway? HeartFlow works on the CCTA you already order, so the physician can get a physiology estimate without a separate test. Let's measure your current time to decision first, then see what changes."
Objection: "Is HeartFlow covered by our commercial and Medicare payers in Southern California?"
Response: "Coverage is local and patient-specific. Medicare in Southern California (Noridian JE) has an LCD (L38613) that names FFRCT and allows it for defined patients, chiefly intermediate-risk chest pain with a 40–90% proximal or mid stenosis on CCTA, with listed exclusions. Medicare Advantage plans follow Medicare coverage rules but can have their own prior-authorization steps. Aetna and Cigna/eviCore policies we reviewed cover FFR-CT for CAD of uncertain significance on a recent CCTA. For Anthem, SCAN, Optum, Health Net, L.A. Care and Medi-Cal, let's confirm with the plan. Please verify with your billing team against the current policy text." Plan-specific coverage Unverified
Southern California Cardiovascular Payer & Reimbursement Landscape
Capitation, IPAs, Medi-Cal, and Outpatient BillingManaged care is prominent in Los Angeles: delegated-risk medical groups/IPAs, Medicare Advantage, and Medi-Cal managed care. Verify current penetration data and contract structure for each account. Positioning HeartFlow requires tailoring the economic conversation to who holds financial risk for institutional inpatient costs.
Optum-affiliated groups; Heritage Provider Network (Regal, Lakeside)
Financial Model: The medical group/IPA receives a capitated PMPM payment and may share risk on hospital institutional pools. Contract terms vary; confirm current group names and arrangements before meetings.
Value Equation: Each avoided low-yield diagnostic cath is spend the risk pool does not pay; ask the group for its own allowed amount per cath. In PLATFORM, about 60% of planned ICAs in the FFRCT-guided cohort were cancelled (small non-randomized study); a local rate will differ.
SCAN Health Plan, Alignment Health, UnitedHealthcare MA
Financial Model: A large share of Medicare beneficiaries in LA County (verify the current CMS penetration file). Quality-incentivized via CMS Star Ratings and HEDIS measures.
Value Equation: CCTA + FFRCT is consistent with 2021 ACC/AHA recommendations (CCTA Class 1, LOE A; FFR-CT Class 2a, LOE B-NR) in the right patients; stress imaging is also a Class 1 option. In DISCHARGE (CT-first vs ICA-first in intermediate-risk patients referred for ICA), major procedure-related complications were 0.5% vs 1.9%. CCTA-detected plaque is associated with more statin initiation (Generoso 2024 meta-analysis, plaque vs none RR 5.40; mostly observational data).
L.A. Care Health Plan, Health Net
Financial Model: Managed Medi-Cal operating under DHCS's CalAIM program. Plan-specific coverage of FFRCT and plaque analysis is Unverified.
Value Equation: Avoiding an unnecessary invasive angiogram avoids its procedural risk and recovery time. Confirm plan-specific coverage before discussing; time-to-diagnosis and work-day effects need local data Unverified.
Reimbursement Coding & Coverage Architecture (Southern California MAC: Noridian JE)
Retrieved 2026-09-29 · verify before external use- CPT 75574: coronary CT angiography, with contrast, including 3D image postprocessing (anatomic foundation; FFRCT is added on top).
- CPT 75580: noninvasive estimate of coronary FFR derived from augmentative software analysis of CCTA data, with interpretation and report. Category I since Jan 1, 2024 (replaced Category III 0501T–0504T). Report once per CCTA; with 75574 when done the same day. The code is vendor-neutral.
- CPT 75577: quantification and characterization of coronary atherosclerotic plaque from augmentative software analysis of CCTA data, with interpretation and report. Category I since Jan 1, 2026 (replaced Category III 0623T–0626T).
- Separately payable under OPPS (status indicator S) when covered. CY2026 national unadjusted rates (CMS Addendum B, July 2026 update): 75574 APC 5572, $356.43; 75580 APC 5724, $877.34; 75577 APC 1511, $950.50. Rates update quarterly; a payment rate is not a coverage decision.
- Margin varies: margin on a diagnostic cath differs by hospital, setting and payer. Ask the account's finance team for local numbers Unverified: DRG-loss claim removed.
Medicare Coverage in Southern California
Local coverage; no national coverage determination- MAC: Noridian Healthcare Solutions, Jurisdiction E (California, Nevada, Hawaii, Guam, American Samoa, Northern Mariana Islands). CMS has no NCD for FFR-CT; coverage is local.
- FFRCT: Noridian LCD L38613 and Billing/Coding Article A58095 (effective 2026-03-05; JE and JF unified) state that FDA-approved FFRCT may be considered reasonable and necessary for intermediate-risk patients with acute or stable chest pain and a 40–90% proximal or mid stenosis on CCTA (plus two additional non-obstructive-CAD scenarios), with listed exclusions (for example prior CABG or stents, recent MI, suspected ACS). The claim must report the referring physician's name and NPI.
- AI plaque analysis: Noridian LCD L39881 and Article A59769 (75577 added 2026-01-01): reasonable and necessary for acute or stable chest pain with no known CAD when CCTA shows intermediate risk or CAD-RADS 1–3 and ACS evaluation is negative or inconclusive; not for screening, normal CCTA, high-grade stenosis (>70% or CAD-RADS 4/5) or surveillance. Criteria from page summary: confirm verbatim
- Commercial and MA plans: MA plans must follow Medicare coverage rules but may add prior-authorization steps. Aetna (CPB 0228) and Cigna/eviCore cover FFR-CT for CAD of uncertain physiologic significance on a recent CCTA; Blue Shield of California's policy (effective 2023; may be superseded) covers it after a positive CCTA in intermediate-risk stable chest pain. Anthem, SCAN, Optum, Health Net, L.A. Care and Medi-Cal Unverified. Payer wording comes from web retrieval on 2026-09-29: confirm current policy text.
Coverage depends on the plan and the patient. Verify with the practice's billing team and the current LCD/policy text before quoting to a customer.
These headline numbers come from different studies, designs and populations and should not be combined or compared with each other. Open the Evidence Matrix pop-outs for what each one does and does not show.
CCTA is a Class 1 (Level of Evidence A) recommendation in the 2021 ACC/AHA chest pain guideline for diagnosis, risk stratification and guiding treatment in intermediate-high risk patients with stable chest pain and no known CAD. Stress imaging is also a Class 1 option; test choice depends on patient factors and local expertise. The same scan also shows coronary plaque, whether or not a stenosis is flow-limiting (see Step 5).
Comprehensive Cardiovascular Evidence Matrix
Full Research Library BreakdownShowing 13 of 13 studies.
- Tag legend
- FFRct FFRct (CT-derived physiology) is analyzed
- Plaque plaque burden or composition is analyzed
- CCTA CCTA-based pathway or anatomy
- MISC none of the three
Select any colored result (marked ⓘ) to open its pop-out: what the number means, where it came from, what not to claim, and field anchors. Close with Esc or the Close button.
| Study Family | Tags | Design & Cohort | Primary Endpoint | Key Quantitative Result | Executive & Field Meaning |
|---|---|---|---|---|---|
| Western Denmark FFRCT Registry Study (2018) Observational cohort (Nørgaard, JACC 2018) | FFRct |
3,674 consecutive stable chest-pain patients evaluated with first-line CCTA; the 677 with intermediate (30-70%) stenosis received FFRCT to guide downstream care | Composite of all-cause death, MI, hospitalization for unstable angina and unplanned revascularization (median follow-up 24 months) | Real-world observational data that a negative FFRCT (>0.80) is followed by a low event rate over about 2 years, close to patients with minimal disease on CCTA. Not randomized and not powered to prove equivalence. | |
| NXT Trial (2014) & Calcification Substudy (2015) Prospective diagnostic study + substudy (JACC / JACC Imaging) | FFRct |
NXT: 254 patients (484 vessels) with suspected CAD scheduled for invasive angiography; CCTA, FFRCT and invasive FFR compared. Calcification substudy: 214 of those patients with Agatston scores (333 vessels with FFR in 163 patients). | NXT: per-patient diagnostic performance (AUC, sensitivity, specificity) of FFRCT vs invasive FFR <=0.80. Substudy: performance of FFRCT across Agatston-score quartiles and in high vs low-to-mid calcium. | 2014 · Primary trial 2015 · Calcification substudy |
FFRCT kept high discrimination of flow-limiting disease across calcium levels and beat CCTA stenosis alone, although accuracy and specificity trended lower at the highest calcium. It supports using FFRCT in calcified vessels; it does not remove calcium as a limitation. |
| PLATFORM (2015/16) Prospective non-randomized cohorts | FFRctCCTA |
584 patients at 11 European sites, enrolled in two strata: planned invasive angiography (n=380; 187 usual care vs 193 CTA/FFRCT-guided) and planned noninvasive testing (n=204; 100 vs 104), in sequential cohorts. | Percentage of planned-ICA patients found to have no obstructive CAD at catheterization within 90 days (no stenosis of 50% or more by core-lab QCA and no invasive FFR below 0.80); secondary: MACE, medical costs, quality of life (90 days and 1 year). | 2015 · Primary trial (EHJ) 2015 · Economic & QoL analysis (JACC) 2016 · 1-year outcomes (JACC) |
In patients already scheduled for ICA, a CTA/FFRCT-first pathway cancelled most planned angiograms and lowered 90-day medical costs, with low event rates (small study, non-randomized, not powered for noninferiority). In planned noninvasive-testing patients, costs did not differ significantly. |
| ADVANCE Registry (2018/20) Prospective registry (38 sites) | FFRctCCTA |
5,083 patients with suspected CAD and at least 30% stenosis on CCTA, enrolled at 38 sites in Europe, North America and Japan (Jul 2015 to Oct 2017); FFRCT analysable in 4,737. | 2018: management-plan reclassification, CCTA alone vs CCTA plus FFRCT (core lab); 90-day outcomes. 2020: 1-year MACE (all-cause death, MI, or ACS with unplanned hospitalization leading to revascularization), with CV death or MI as an exploratory outcome. | 2018 · Clinical utility & decision-making (EHJ) 2020 · 1-year outcomes (JACC Imaging) |
Real-world registry data: FFRCT changed the CCTA-based management plan in about two of three patients, and event rates were low when FFRCT was above 0.80 (most patients given a medical-therapy plan stayed on it, 92.9%). Observational; not proof that deferral is safe, and not a treatment-effect estimate. |
| ADVANCE-DK Registry (2023 / 2025) Prospective Danish registry follow-up (3-yr & 7-yr) | FFRctCCTA |
900 patients with new-onset stable angina and at least one 30%+ stenosis on CCTA, enrolled Dec 2015–Oct 2017 at three Danish ADVANCE sites: 523 normal (FFRCT >0.80) and 377 abnormal (≤0.80) CT-FFR; 394 with coronary calcium (Agatston) ≥400 (182 normal, 212 abnormal). Nonrandomized. Follow-up: 3 years (2023 paper) and mean 7.0 years, range 6.3–8.2 (2025 paper). | 3-year paper (2023): all-cause death or nonfatal spontaneous MI. 7-year paper (2025): cardiovascular death or spontaneous MI. The endpoints differ, so the two sets of percentages are not directly comparable. | 2023 · 3-year follow-up 2025 · 7-year follow-up |
Danish registry data: patients with a normal CT-FFR had a lower rate of death or MI than those with an abnormal result at 3 years (2.1% vs 6.6%) and at 7 years (5.7% vs 12.5%; different endpoints), including patients with high calcium. A prognostic association in a nonrandomized registry; it does not show that acting on the result changes outcomes. |
| PACIFIC (2017) & FFRCT Substudy (2019) Prospective single-centre head-to-head study + post hoc substudy | FFRctCCTA |
208 patients with suspected stable CAD (VU University Medical Center, Amsterdam) had CCTA, SPECT, [15O]H2O PET and 3-vessel invasive FFR. In the substudy, FFRCT was retrospectively computed: 505 of 612 vessels evaluable; 157 patients fully evaluable. | 2017: diagnostic accuracy of CCTA, SPECT, PET and hybrid imaging vs invasive FFR <=0.80. 2019: FFRCT vs CCTA, SPECT and PET by AUC, sensitivity, specificity and accuracy against invasive FFR. | 2017 · Primary trial 2019 · FFRct substudy |
In evaluable vessels FFRCT discriminated flow-limiting lesions better than CCTA, SPECT and PET on a per-vessel basis (post hoc, single centre). Per patient it was comparable to PET, and on an intention-to-diagnose basis PET performed better. It supports FFRCT as a strong lesion-specific test; it does not show FFRCT is superior to all stress imaging. |
| FFRCT RIPCORD (Curzen et al., 2016) Consensus re-planning study (NXT dataset) | FFRct |
200 consecutive stable chest-pain patients from the NXT trial (all had CTA and invasive angiography with FFR); three interventional cardiologists set a management plan by consensus from CTA alone, then again after FFRCT was revealed. | Difference in management plan (medical therapy, PCI, CABG, or more information required) between CTA alone and CTA plus FFRCT; secondary: vessel-level significance and PCI target vessels. | FFRCT often disagreed with CTA anatomy and changed simulated consensus plans in about one in three cases. It is a proof-of-concept about decision-making, not evidence of fewer stents or better outcomes. | |
| PRECISE Trial (2023) Pragmatic randomized strategy trial | CCTAFFRct |
2,103 stable-symptom patients without known CAD, randomized 1:1 (1,057 vs 1,046) to a risk-based precision strategy (PROMISE minimal-risk score: defer testing if minimal risk, otherwise CCTA with selective FFRCT) vs usual testing | 1-year composite: invasive catheterization without obstructive CAD (efficiency) plus death or nonfatal MI (safety) | Supports a risk-based, CCTA-first strategy (deferred testing for minimal-risk patients, CCTA with selective FFRCT for others) as more efficient at 1 year; safety needs confirmation in further trials. | |
| FISH&CHIPS (UK NHS, 2025) Observational NHS cohort (before vs after) | FFRct |
Retrospective observational cohort of 90,553 CCTA patients at 27 NHS England hospitals (2017-2020), compared before vs after FFRCT became available (35,688 vs 54,865; 7,863 actually received FFRCT), under NICE guidance and central NHS funding | 2-year safety (all-cause and CV death, MI) and resource outcomes (ICA, ICA without revascularization, downstream noninvasive tests) | Observational evidence that a nationally funded FFRCT rollout was feasible across 27 NHS hospitals and was associated with fewer invasive and noninvasive downstream tests at 2 years. Not causal; MI signal and cost need follow-up. | |
| PROMISE (2015) & FFRCT Substudy (2017) Randomized trial + nested observational substudy | CCTAFFRct |
PROMISE: 10,003 symptomatic patients randomized to initial CTA (4,996) or functional testing (5,007). FFRCT substudy: 181 CTA-arm patients referred to ICA within 90 days, FFRCT computed retrospectively at a blinded core lab | PROMISE: death, MI, unstable-angina hospitalization or major procedural complication. FFRCT substudy: revascularization or MACE, plus agreement of FFRCT with CTA/ICA stenosis | 2015 · Primary trial 2017 · FFRct substudy |
Anatomy and hemodynamics disagreed in about 30% of patients referred to ICA, and FFRCT was a stronger marker of later revascularization or MACE than severe CTA stenosis (small, retrospective, hypothesis-generating). The primary trial showed no outcome difference between CTA-first and functional-first testing. |
| SCOT-HEART 5-Yr (2018) & Plaque Substudy (2020) Open-label RCT + post hoc plaque analysis | CCTAPlaque |
4,146 stable chest pain patients from 12 Scottish cardiology clinics randomized to standard care + CCTA (2,073) vs standard care alone (2,073). Plaque substudy: 1,769 analyzable CCTA-arm scans | 5-year coronary heart disease death or nonfatal MI. Plaque substudy: fatal or nonfatal MI | 2018 · 5-year primary trial 2020 · Low-attenuation plaque substudy |
CCTA-guided care added to standard care was associated with fewer CHD deaths or nonfatal MIs and more preventive therapy. A separate post hoc analysis showed low-attenuation plaque burden (>4%) marks higher MI risk. Not a HeartFlow trial; plaque quantification was not shown to change outcomes. |
| FORECAST Trial (2021) Open-label randomized trial (UK) | FFRctCCTA |
1,400 stable chest-pain patients randomized at 11 UK Rapid Access Chest Pain Clinics to CTCA with selective FFRCT (experimental) or standard NICE-guided care pathways (standard; 63% had an initial CTCA). | Primary: total cardiac costs at 9 months. Secondary: angina (SAQ), quality of life (EQ-5D-5L), MACCE, and use of invasive coronary angiography. | CTCA with selective FFRCT reduced invasive angiography without a significant difference in cost, MACCE, angina or quality of life. The trial hypothesized cost savings and did not show them; cost neutrality is not proven (CI up to +23%; UK NHS tariffs). | |
| DISCHARGE Trial (NEJM 2022) Pragmatic randomized trial (CT vs ICA) | CCTA |
3,667 stable chest pain patients (intermediate pretest probability, already referred for ICA) randomized at 26 European centers to CT-first (1,833) or ICA-first (1,834); 3,561 analyzed | MACE (CV death, nonfatal MI, nonfatal stroke) over a median 3.5 years; key secondary: major procedure-related complications, angina | In intermediate-risk patients already referred for cath, a CT-first strategy had similar MACE and fewer major procedural complications than ICA-first. |
Illustrative scenario tool, not a forecast. Only the study-sourced defaults are cited; all other inputs are assumptions you should replace with the account's own data.