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CT coronary angiography: a paradigm shift for functional imaging tests
  1. Khaled Alfakih1,2,
  2. Jonathan Byrne2 and
  3. Mark Monaghan2
  1. 1 Department of Cardiology, University Hospital Lewisham, London, UK
  2. 2 Department of Cardiology, King’s College Hospital, London, UK
  1. Correspondence to Dr Khaled Alfakih; khaled.alfakih{at}


The UK National Institute for Health and Care Excellence (NICE) have just updated their guideline on new-onset stable chest pain, recommending that all patients should be investigated with a CT coronary angiography (CTCA). In a separate guideline, NICE recommended CT fractional flow reserve (CT-FFR), to assess coronary stenoses, found on CTCA, stating that this would reduce the need for invasive coronary angiography and hence reduce cost. We discuss the evidence base for CT-FFR and emphasise that we already have established functional imaging tests, with extensive evidence base for efficacy and prognosis and that CT-FFR should be compared with this standard of care and not with the much more expensive and invasive fractional flow reserve undertaken during invasive coronary angiography.

  • chest pain clinic
  • CT scanning
  • stress

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  • Contributors All three authors contributed to the idea and content. KA wrote the manuscript. MM and JB critiqued the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available for this article.

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