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However, invasive fractional flow reserve (FFR) is the current standard to determine the haemodynamic significance of coronary stenosis. Non-invasive and less-invasive imaging techniques such as computed-tomography-derived FFR (FFR-CT) and angiography-derived FFR (QFR) combine both anatomical and functional information in complex algorithms to calculate FFR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial design<\/jats:title><jats:p>The iCORONARY trial is a\u00a0prospective, multicentre, non-inferiority randomised controlled trial (RCT) with a\u00a0blinded endpoint evaluation. It investigates the costs, effects and outcomes of different diagnostic strategies to evaluate the presence of CAD and the need for revascularisation in patients with stable angina pectoris who undergo coronary computed tomography angiography. Those with a\u00a0Coronary Artery Disease\u2014Reporting and Data System (CAD-RADS) score between 0\u20132 and\u00a05 will be included in a\u00a0prospective registry, whereas patients with CAD-RADS\u00a03 or 4A will be enrolled in the RCT. The RCT consists of three randomised groups: (1)\u00a0FFR-CT-guided strategy, (2)\u00a0QFR-guided strategy or (3)\u00a0standard of care including ICA and invasive pressure measurements for all intermediate stenoses. The primary endpoint will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at 1\u00a0year. Clinicaltrials.gov-identifier: NCT04939207.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The iCORONARY trial will assess whether a\u00a0strategy of FFR-CT or QFR is non-inferior to invasive angiography to guide the need for revascularisation in patients with stable CAD. Non-inferiority to the standard of care implies that these techniques are attractive, less-invasive alternatives to current diagnostic pathways.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s12471-023-01758-3","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T18:03:27Z","timestamp":1675188207000},"page":"150-156","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rationale and design of the iCORONARY trial: improving the cost-effectiveness of coronary artery disease diagnosis"],"prefix":"10.1007","volume":"31","author":[{"given":"J.","family":"Peper","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. M.","family":"Becker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. 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Budde discloses institutional support from HeartFlow and Siemens. J.\u00a0Habets discloses institutional support from Canon Medical Systems. J.\u00a0Peper, L.\u00a0M. Becker, T.\u00a0A. Bruning, W.\u00a0G. van Dockum, G.\u00a0W.\u00a0J. Frederix, J.\u00a0P.\u00a0S. Henriques, P.\u00a0Houthuizen, F.\u00a0A.\u00a0A. Mohamed Hoesein, R.\u00a0N. Planken, M.\u00a0Voskuil, M.\u00a0L. Bots, T.\u00a0Leiner and M.\u00a0J. Swaans declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}