Monday, September 07, 2015


Taking the cue from Dr Alan Teh, I thought that I better read up on what happened at the just concluded ESC ( European Society of Cardiology), Annual Congress 2015, London . I found a very interesting presentation, which to me, had a very important and practical message for Malaysian Cardiology and Cardiac investigation scene.
Dr Pamela Douglas ( that sharp lady ), from Dukes Clinical Research Institute, Durham, N Carolina, presented the results of the PLATFORM ( Prospective Longitudinal Trial of FFRct : Outcome and Resource Impact ) study. Basically, this study looked into the usefulness and impact of a plain CTA, against a CTA with FFR analysis with the Heartflow software, done offline. PLATFORM has 2 different arms and I will describe that arm that has to do with comparing CTA without FFR and CTA with FFR or FFRct. ( these are non invasive FFR ).
Dr Douglas and colleagues studied 380 patients, who had CTA, who were all scheduled for coronary angiogram, She divided them into 2 groups. One group when straight for coronary angiogram ( 187 patients ), Gp A and the other group ( 193 pts ) had FFRct before Coronary angiogram, Gp B.
They found that in Gp A, 73% of patients had NO significant coronary artery disease and after 3 months followup, non had any coronary events. While in Gp b, following FFRct, they were confident to cancel 61% of the coronary angiogram, without any follow-up incidences, and in the remaining 39% who had coronary angiogram done, 12% had no significant coronary disease.
Take awhile to have the message sink in. After all these years, if PLATFORM is to be believed, we have a 73% coronary angiograms where no significant disease is found. And in 61%, the coronary angiogram could be safely excluded.
Just imagine the abuse all these years and which will probably will be carried on by the CTA-philes for many more years to come. I suppose it would be too drastic to say that  these people are  "CTA for bread".

When I saw these figures, I was appalled. Thanks Dr Douglas for enlightening us. I hope that many more centers, especially local ones will repeat this study and see where we stand. I firmly believe that FFRct is the way to go.
We have been advocating a clinical approach to investigation of CAD,, instead of a factory, everyone get CTA approach, as often done in many medical centers on the rational that what you see is real. Well I hope that cardiologist will wake up and realise that what you see may not be real and adding a functional component would greatly assist in the accuracy and patient care management aspect of diagnosis of CAD. I of course assume that we are clinicians and not businessmen.


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