On-Site Computed Tomography-Derived Fractional Flow Reserve to Guide Management of Patients with Stable Coronary Artery Disease: the TARGET Randomized Trial

Yang, J.

doi:10.1161/CIRCULATIONAHA.123.063996

TARGET (CT-FFR)

On-Site Computed Tomography-Derived Fractional Flow Reserve to Guide Management of Patients with Stable Coronary Artery Disease: the TARGET Randomized Trial

Patient / Population Intervention / Exposure Comparison Outcome

In 1,216 patients with stable coronary disease and an intermediate stenosis on CT angiography, an on-site machine-learning CT-FFR care pathway reduced invasive angiography without obstructive disease or intervention within 90 days compared with standard care.

N

1,216patients

Design

Multicentre RCT, China (6 centres)

Endpoint

Proportion of patients undergoing invasive coronary angiography without obstructive CAD, or with obstructive disease not undergoing intervention, within 90 days

Relevance

2Important — one of several pillars.

ResultPrimary endpoint 28.3% (119/421) vs 46.2% (223/483) (P<0.001); invasive angiography in 69.2% vs 79.4%; revascularisation 49.7% (302/608) vs 42.8% (260/608) (P=0.02); 1-year MACE HR 0.88 (95% CI 0.59–1.30); quality of life and symptoms improved similarly.

Yang J, et al. Circulation. 2023;147(18):1369-1381. 10.1161/CIRCULATIONAHA.123.063996

Discussion & critique

The first RCT of on-site machine-learning CT-FFR as a care pathway: it met its primary endpoint by cutting non-actionable invasive angiograms, but revascularisation increased overall without any improvement in symptoms, quality of life or 1-year MACE — both results need saying together. Open-label, a process endpoint, and a cost trend (−4,233 yuan, P=0.07) that did not reach significance; whether the extra revascularisation helped or harmed is unanswered at one year.