PLATFORM: Economic and Quality of Life Outcomes of an FFRCT Diagnostic Strategy in

Suspected CAD

Mark A Hlatky, Bernard De Bruyne, Gianluca Pontone, Manesh Patel, Alan Wilk, Campbell Rogers, Pamela Douglas,

PLATFORM Investigators

Supported by HeartFlow, Inc.

Disclosure Statement of Financial Interest

Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organizations listed below.

Affiliation/Financial Relationship Company

• Grant/Research Support HeartFlow, Inc

• Consulting Fees/Honoraria Blue Cross Blue Shield

J Am Coll Cardiol

Acumen, Inc

• Royalty Income Up-to-Date

Background and Aim Optimal evaluation of new onset stable chest pain is

uncertain

CTA provides anatomic information, and is highly sensitive, but does not define the functional significance of lesions

Fractional flow reserve can now be estimated from standard CTA data (FFRCT)

In PLATFORM, use of FFRCT reduced rate of invasive angiography without obstructive CAD by 61%

AIM: Assess economic and QOL outcomes of using CTA with FFRCT instead of usual care

Study Design

Patients with stable symptoms, intermediate probability of CAD, and no established CAD diagnosis

Referred for planned invasive or planned non-invasive evaluation at 11 European centers

Consecutive cohorts: usual care, CTA + FFRCT

Resource use over 90 days, cost weights from US Medicare

QOL changes from baseline to 90 days with Seattle Angina Questionnaire, EuroQOL

Baseline Characteristics

Planned Planned Invasive Non-Invasive Usual Care FFRCT Usual Care FFRCT (N=187) (N=193) (N=100) (N=104)

Age 63 61 58 59

Male 58% 62% 66% 58%

Atypical Pain 65% 74% 91% 77%

Prior Testing 49% 52% 0% 5%

Prob CAD 52% 49% 45% 45%

Key Resource Use Within 90 Days

Planned Planned Invasive Non-Invasive Usual

Care FFRCT Usual Care FFRCT (N=187) (N=193)

(N=100) (N=104)

Stress Tests 4 9 51 9

CTA 1 193 60 104

FFRCT 0 117 0 60

Dx Angio 153 37 9 10

PCI 44 51 4 9

Costs Over 90 Days

Sensitivity Analysis No Medicare cost-weight yet for FFRCT

• Primary analysis used $0 to estimate cost offsets

• Multiples of CTA cost weight in sensitivity analysis

Scenario Usual Care FFRCT P

Invasive

0 x CTA $10,734 $7,343<0.0001

7 x CTA $10,734 $8,619<0.0001

Non-Invasive

0 x CTA $ 2,137 $2,679 0.26

0.5 x CTA $ 2,137 $2,766 0.02

Changes in SAQ, Baseline to 90 Days

Limitations

Not randomized or blinded

Conducted in Europe, not in the US

Only Medicare price weights used

Conclusions

In symptomatic patients with intermediate probability of CAD, evaluation strategies based on FFRCT had

• Lower cost than invasive coronary angiography

• Greater improvement in QOL than usual non-invasive testing

Published today in J Am Coll Cardiol