On Demand: CCTA Operational Efficiencies: The Nurse Navigator Role and Other Practical Approaches to Program Growth-PRECISE Data Sheet

PRECISE Data Sheet

Pdf Summary

The PRECISE Trial analyzed the efficacy of a Precision Pathway versus Traditional Testing for managing stable symptomatic patients with suspected Coronary Artery Disease (CAD). Traditional Testing included functional tests (like stress nuclear and stress echo) and invasive coronary angiography (ICA), with risk scoring to defer low-risk patients. The Precision Pathway utilized Coronary Computed Tomography Angiography (CCTA) and selective fractional flow reserve (FFRCT) for elevated risk patients.<br /><br />With 2,103 patients from 65 global sites, the study was a prospective randomized controlled trial providing Level 1 evidence. It aimed to evaluate if a CCTA/FFRCT-centered strategy could offer superior patient outcomes compared to traditional methods.<br /><br />The primary endpoint evaluated a composite of death, nonfatal myocardial infarction (MI), or ICA without obstructive CAD within one year. Results showed the Precision Pathway achieved a 70% reduction in these adverse outcomes compared to Traditional Testing. Specifically, the Precision Pathway group had a primary endpoint event rate of 4.2%, compared to 11.3% in the Traditional Testing group.<br /><br />Key findings emphasized the Precision Pathway's effectiveness in producing more accurate non-invasive diagnostics, reducing unnecessary tests, and increasing the identification of patients needing revascularization. It yielded a higher proportion of successful diagnostic catheterizations, sparing many patients from unnecessary ICA procedures. Patients in the Precision Pathway were more likely to be prescribed lipid-lowering and antiplatelet agents, indicating enhanced preventive care. Notably, 32% fewer initial tests were conducted by safely deferring with patient risk stratification, reducing both false negatives and false positives.<br /><br />The study's findings support the Precision Pathway as the preferred diagnostic and treatment pathway, aligning with AHA/ACC guidelines, illustrating its superiority in managing patients with stable chest pain or equivalent symptoms requiring CAD testing.

Keywords

Precision Pathway

Traditional Testing

Coronary Artery Disease

CCTA

FFRCT

randomized controlled trial

patient outcomes

diagnostic catheterizations

preventive care

AHA/ACC guidelines