Results from the FORECAST Trial reported at TCT Connect

October 16, 2020

NEW YORK - October 16, 2020 - In the FORECAST randomized clinical trial, the use of fractional flow reserve management derived from computed tomography (FFRCT) did not significantly reduce costs but did reduce the use of invasive coronary angiography (ICA).

Findings were reported today at TCT Connect, the 32nd annual scientific symposium of the Cardiovascular Research Foundation (CRF). TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine.

FFRCT is a novel, validated, non-invasive method for describing both the amount of coronary atheroma from a CT coronary angiogram (CTCA), but also vessel-specific ischemia derived from the CTCA and other clinical parameters using a fluid dynamics computer model. Previous studies have indicated that FFRCT reduces the uptake of invasive angiography that shows no significant CAD, without compromising patient safety. The clinical effectiveness and economic impact of using FFRCT instead of other tests in the evaluation of patients with stable chest pain has not yet been tested in a randomized trial, although based upon cost models on observational data, FFRCT is already recommended in routine clinical practice by National Institute for Health and Care Excellence (NICE) in the UK, because it appeared cost dominant.

The primary endpoint of the FORECAST trial was resource utilization derived from non-invasive cardiac tests, invasive angiography, coronary revascularization, hospitalization for a cardiac event, and cardiac medications at nine months. Prespecified secondary endpoints included major adverse cardiac and cerebrovascular events, revascularization, angina severity, and quality of life (QOL).

In the trial, 1,400 patients with stable chest pain at 11 UK centers were randomized to receive either CCTA with FFRCT of lesions with stenosis severity of 40% or greater (test arm, n=699) or routine assessment as directed by the NICE Guideline for Chest Pain of Recent Onset (reference arm, n=700). The routine assessment arm included a mixture of non-invasive tests, including CCTA (without FFRCT) in 61.4% of subjects. The mean age of the overall population was 60 (25-89) years and 52% were male. Baseline demographics, angina status, and QOL/health status were similar between the groups.

In patients presenting with new onset stable chest pain, a strategy of CTCA with FFRCT, when compared with a strategy of routine care, did not significantly reduce average total costs in the NHS system (£1,605.50 vs. £1,491.46, p=0.962). At nine months, the number of patients in the test arm who underwent the following non-invasive tests were: CTCA (674), FFRCT (220), stress echo (13), perfusion scan (4), stress MRI (15), exercise ECG (27). The number of patients in the reference arm who underwent these tests were: CTCA (460), FFRCT (9), stress echo (124), perfusion scan (34), stress MRI (20), and exercise ECG (99). A total of 22% fewer patients in the test group had invasive coronary angiography (ICA) compared to the reference group (136 vs. 175, p=0.01). There was no significant difference in the rates of MACCE or revascularization.

"Results from FORECAST indicate that CTCA and FFRCT as a frontline strategy may not be associated with the financial savings projected from observational data by NICE," said Nick Curzen, BM (Hons), PhD, Professor of Interventional Cardiology, University of Southampton, United Kingdom. "However, the reduction in invasive coronary angiography is important and will be very attractive to patients. More data is needed to determine the optimal use for FFRCT in clinical practice."
The FORECAST trial was an investigator-initiated study with an unrestricted research grant from HeartFlow. Dr. Curzen reported the following disclosures: speaker fees and travel sponsorship from HeartFlow in the last 3 years.

About CRF

The Cardiovascular Research Foundation (CRF) is one of the world's leading nonprofit organizations specializing in interventional cardiology innovation, research, and education. CRF is dedicated to helping doctors improve survival and quality of life for people suffering from heart and vascular disease. For nearly 30 years, CRF has helped pioneer medical advances and educated doctors on the latest treatments for heart disease. CRF is comprised of the CRF Skirball Center for Innovation, CRF Clinical Trials Center, CRF Center for Education, CRF Digital, TCTMD, and Structural Heart: The Journal of the Heart Team.

Transcatheter Cardiovascular Therapeutics (TCT) is the annual scientific symposium of CRF and the premier educational meeting specializing in interventional cardiovascular medicine. Now in its 32nd year, TCT features major medical research breakthroughs and gathers leading researchers and clinicians from around the world to present and discuss the latest evidence-based research in the field.

For more information, visit and

Cardiovascular Research Foundation

Related Chest Pain Articles from Brightsurf:

New approach helps EMTs better assess chest pain en route to hospital
A study conducted at Wake Forest Baptist Health shows that on-scene use of a new protocol and advanced diagnostic equipment can help paramedics better identify patients at high risk for adverse cardiac events.

Brain activity during psychological stress may predict chest pain in people with heart disease
The brain's reaction to stress could be an important indicator of angina (chest pain) among people with known heart disease.

Chest pain, stress tests warrant attention even if arteries are clear
Patients who experience chest pain and have abnormal results on a cardiac stress test but who do not have blocked arteries often experience changes in their symptoms and stress test results over time, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Women carry heavier burden of chest pain, but less artery narrowing
Women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have significantly more chest pain caused by plaque build-up, yet less extensive disease as compared with men, according to new research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

More isn't better when it comes to evaluating chest pain
New and more effective tests are needed to help predict heart attacks and other major cardiac events in patients with chest pain, the second most common reason for emergency department visits in the US.

Artificial intelligence could prevent unneeded tests in patients with stable chest pain
Artificial intelligence (AI) could prevent unnecessary diagnostic tests in patients with stable chest pain, according to research presented today at ICNC 2019.

Kaiser Permanente improves emergency care for patients with chest pain
Emergency physicians at Kaiser Permanente hospitals in Southern California reduced hospital admissions and cardiac stress testing by using new criteria to assess the level of risk patients with chest pain have for subsequent cardiac events.

Treatment for underdiagnosed cause of debilitating chest pain
Researchers find an effective way to treat an underdiagnosed condition that can cause heart attack and heart-attack-like symptoms.

Diagnostic protocol effective in identifying ED patients with acute chest pain
A relatively new accelerated diagnostic protocol is effective in identifying emergency department patients with acute chest pain who can be safely sent home without being hospitalized or undergoing comprehensive cardiac testing, according to researchers at Wake Forest Baptist Medical Center.

Chest pain drug falls short in preventing first episode of ventricular arrhythmia or death
A trial of more than 1,000 patients with implantable cardioverter defibrillators found that the drug ranolazine (used to treat chest pain; brand name Ranexa®) was safe but didn't decrease the likelihood of the first occurrence of ventricular arrhythmias or death in this high-risk population.

Read More: Chest Pain News and Chest Pain Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to