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In this study, we report real-world data on the feasibility of implementing a CTA\/FFR<jats:sub>CT<\/jats:sub> test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30\u201389%) by CTA. Evaluation of CTA datasets, interpretation of FFR<jats:sub>CT<\/jats:sub> analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFR<jats:sub>CT<\/jats:sub> 375 (81%) and perfusion imaging 88 (19%). FFR<jats:sub>CT<\/jats:sub> analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFR<jats:sub>CT<\/jats:sub> was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFR<jats:sub>CT<\/jats:sub>-guided versus CTA-guided referral to ICA: 30\u201369% stenosis, 28 (44%) versus 8 (21%); 70\u201389% stenosis, 39 (69%) versus 25 (46%), respectively, both <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05. Implementation of FFR<jats:sub>CT<\/jats:sub> at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate.<\/jats:p>","DOI":"10.1007\/s10554-024-03214-8","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T06:02:27Z","timestamp":1726034547000},"page":"2213-2220","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Selective FFRCT testing in suspected stable angina in clinical practice\u00a0-\u00a0initial experiences"],"prefix":"10.1007","volume":"40","author":[{"given":"Shifan","family":"Thangavel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian Taekker","family":"Madsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels Peter","family":"R\u00f8nnow Sand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karsten Tange","family":"Veien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lone","family":"Deibjerg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majed","family":"Husain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Hosbond","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilek Hunerel","family":"Alan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian Altern","family":"\u00d8vrehus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders","family":"Junker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Mortensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian Korsgaard","family":"Thomsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisette Okkels","family":"Jensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina Svenstrup","family":"Poulsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flemming Hald","family":"Steffensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Rohold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Busk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"issue":"12","key":"3214_CR1","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1093\/ehjci\/jeaa197","volume":"21","author":"L Nissen","year":"2020","unstructured":"Nissen L et al (2020) Implementation of coronary computed tomography angiography as nationally recommended first-line test in patients with suspected chronic coronary syndrome: impact on the use of invasive coronary angiography and revascularization. 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All other authors had no disclosures to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}