Lessons from PLATFORM - Nick Curzen

1. Nick Curzen BM(Hons) PhD FRCP
Professor of Interventional Cardiology
University Hospital Southampton NHS FT
Lessons from PLATFORM
3 October 2016

2. 3 October 2016
Potential Conflicts of Interest
Unrestricted research grant for FFRCT RIPCORD HeartFlow
Speaker fees HeartFlow

3. 3 October 2016
We have already established that the addition of FFR to angiographic assessment improves
diagnostic accuracy and therefore optimises management & outcome for patients….
This is because FFR defines both patient-level and lesion-specific ischaemia, which is our target for
revascularisation….
But: how cool would it be if we could achieve anatomical and physiological assessment
of patients and define lesion-specific ischaemia non-invasively?????

4. 3 October 2016
ANATOMY
Identify obstructive CAD
FUNCTION
Identify lesion-specific
ischaemia that may benefit
from PCI
Invasive
Noninvasive
Diagnosing Anatomic and Functionally-Significant CAD

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HeartFlow FFRCT Process
A standard cardiac CT scan is performed and the
data is uploaded to HeartFlow.
3 October 2016

6. HeartFlow FFRCT Process
HeartFlow Analysts use proprietary software to
create a personalized, digital 3D model of the
coronary arteries.
Powerful computer algorithms solve millions of
complex equations to assess the impact that
blockages have on blood flow.
A standard cardiac CT scan is performed and the
data is uploaded to HeartFlow.
3 October 2016

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DISCOVER-FLOW
• Completed 2011
• N=103 patients
High Accuracy of FFRCT Compared to Gold Standard
DeFACTO
• Completed 2012
• N=252 patients NXT
• Completed 2013
• N=254 patients
NXT Per-Vessel
Performance
• Specificity: 86%
• Sensitivity: 84%
• Accuracy: 86%
Data supported 2014
FDA Clearance
Koo et al, JACC 2011.
Min et al, JAMA 2012.
Norgaard et al, JACC 2014.
3 October 2016

8. 3 October 2016
Eur Heart J 2015
Primary endpoint
Percentage of those with planned ICA in whom
no significant obstructive CAD (>50% or FFR<0.8)
was found at ICA within 90 days
Secondary endpoints
Death + MI + unplanned revasc

9. • n=584
• 11 centres
• Assigned to usual care or CTA/FFRCT

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Yes… but is FFRCT cost effective?

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JACC 2015

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JACC 2016

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JACC 2016

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Summary
 FFRCT, in suitable patients, shows high degree of diagnostic accuracy using ICA & FFR as reference
 FFRCT is associated with a dramatically lower rate of ICA showing no obstructive lesions than standard care
 FFRCT is associated with lower resource utilisation without any difference in clinical outcome
 We need a properly powered randomised trial of FFRCT versus routine care to cement the potential in routine care

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