The PLATFORM Trial: An Insight into the Improved Value of Using FFRCT for Reduction of Invasive Angiographic Procedures

Abstract

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.1-5For 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.6However, 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.7-11Thus, 
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.12,13