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Sharma SP, Hirsch A, Hunink MGM, Cramer MJM, Mohamed Hoesein FAA, Geluk CA, Kramer G, Gratama JWC, Braam RL, van der Zee PM, Yassi W, Wolters SL, Gürlek C, Pundziute G, Vliegenthart R, Budde RPJ. Addition of FFRct in the diagnostic pathway of patients with stable chest pain to reduce unnecessary invasive coronary angiography (FUSION) : Rationale and design for the multicentre, randomised, controlled FUSION trial. Neth Heart J 2023; 31:52-60. [PMID: 35976610 PMCID: PMC9892409 DOI: 10.1007/s12471-022-01711-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is widely used in the diagnostic work-up of patients with stable chest pain. CCTA has an excellent negative predictive value, but a moderate positive predictive value for detecting coronary stenosis. Computed tomography-derived fractional flow reserve (FFRct) is a non-invasive, well-validated technique that provides functional assessment of coronary stenosis, improving the positive predictive value of CCTA. However, to determine the value of FFRct in routine clinical practice, a pragmatic randomised, controlled trial (RCT) is required. We will conduct an RCT to investigate the impact of adding FFRct analysis in the diagnostic pathway of patients with a coronary stenosis on CCTA on the rate of unnecessary invasive coronary angiography, cost-effectiveness, quality of life and clinical outcome. METHODS The FUSION trial is a prospective, multicentre RCT that will randomise 528 patients with stable chest pain and anatomical stenosis of ≥ 50% but < 90% in at least one coronary artery of ≥ 2 mm on CCTA, to FFRct-guided care or usual care in a 1:1 ratio. Follow-up will be 1 year. The primary endpoint is the rate of unnecessary invasive coronary angiography within 90 days. CONCLUSION The FUSION trial will evaluate the use of FFRct in stable chest pain patients from the Dutch perspective. The trial is funded by the Dutch National Health Care Institute as part of the research programme 'Potentially Promising Care' and the results will be used to assess if FFRct reimbursement should be included in the standard health care package.
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Affiliation(s)
- S. P. Sharma
- Department of Cardiology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - A. Hirsch
- Department of Cardiology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M. G. M. Hunink
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Epidemiology and Biostatistics, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Centre for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - M. J. M. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - C. A. Geluk
- Department of Cardiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - G. Kramer
- Department of Radiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - J. W. C. Gratama
- Department of Radiology, Gelre Hospital, Apeldoorn, The Netherlands
| | - R. L. Braam
- Department of Cardiology, Gelre Hospital, Apeldoorn, The Netherlands
| | - P. M. van der Zee
- Department of Cardiology, St Jansdal Hospital, Harderwijk, The Netherlands
| | - W. Yassi
- Department of Cardiology, St Jansdal Hospital, Harderwijk, The Netherlands
| | - S. L. Wolters
- Department of Radiology, Adrz Hospital, Goes, The Netherlands
| | - C. Gürlek
- Department of Cardiology, Adrz Hospital, Goes, The Netherlands
| | - G. Pundziute
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - R. Vliegenthart
- Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - R. P. J. Budde
- Department of Cardiology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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