The PLATFORM Trial: An Insight into the Improved Value of Using FFRCT for Reduction of Invasive Angiographic Procedures
DOI:
https://doi.org/10.17140/HROJ-2-e005Abstract
Coronary CT Angiography (CCTA) has been widely used as a reliable non-invasive
modality for the diagnosis of Coronary Artery Disease (CAD) due to its improved spatial and
temporal resolution.1-5 For patients with low to intermediate pre-test probability of CAD, CCTA
is used as an effective gatekeeper for determination of downstream testing, such as invasive
coronary angiography or functional imaging.6 However, CCTA is mainly an anatomic test with
excellent visualization of coronary anatomical structures and detection of coronary lumen stenosis,
while providing little functional information of the coronary lesions. Despite high sensitivity
and negative predictive value, CCTA has been reported to have moderate specificity and
positive predictive value due to the high percentage of false positive rates, and this is especially
apparent in the assessment of coronary arteries with heavy calcification. Studies have shown
the limited diagnostic value of CCTA in diagnosing highly calcified coronary plaques.7-11 Thus,
an imaging technique able to detect ischemia-producing lesions is of paramount importance
since coronary stenosis does not always translate to functional significance. Clinical decision
making of whether patients should proceed to a revascularization procedure is based on the
predictive functional effect of coronary stenosis, because no prognostic benefit of revascularization
has been reported in the coronary lesions without functional significance.
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