1. PLATFORM: Economic and Quality of Life Outcomes of an FFR CT Diagnostic Strategy in Suspected CAD Mark A Hlatky, Bernard De Bruyne, Gianluca Pontone, Manesh Patel, Alan Wilk, Campbell Rogers, Pamela Douglas, PLATFORM Investigators Supported by HeartFlow, Inc.

2. Disclosure Statement of Financial Interest  Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organizations listed below.  Affiliation/Financial RelationshipCompany Grant/Research Support HeartFlow, Inc Consulting Fees/HonorariaBlue Cross Blue Shield J Am Coll Cardiol Acumen, Inc Royalty IncomeUp-to-Date

3. Background and Aim  Optimal evaluation of new onset stable chest pain is uncertain  CTA provides anatomic information, and is highly sensitive, but does not define the functional significance of lesions  Fractional flow reserve can now be estimated from standard CTA data (FFR CT )  In PLATFORM, use of FFR CT reduced rate of invasive angiography without obstructive CAD by 61%  AIM: Assess economic and QOL outcomes of using CTA with FFR CT instead of usual care

4. Study Design  Patients with stable symptoms, intermediate probability of CAD, and no established CAD diagnosis  Referred for planned invasive or planned non- invasive evaluation at 11 European centers  Consecutive cohorts: usual care, CTA + FFR CT  Resource use over 90 days, cost weights from US Medicare  QOL changes from baseline to 90 days with Seattle Angina Questionnaire, EuroQOL

5. Baseline Characteristics Planned Planned Invasive Non-Invasive Usual Care FFR CT Usual Care F FR CT (N=187) (N=193) (N=100) (N=104) Age 63 61 58 59 Male 58% 62% 66%58% Atypical Pain65% 74% 91%77% Prior Testing49% 52% 0% 5% Prob CAD52% 49% 45%45%

6. Key Resource Use Within 90 Days Planned Planned Invasive Non-Invasive Usual Care FFR CT Usual Care FFR CT (N=187) (N=193) (N=100) (N=104) Stress Tests 49 51 9 CTA 119360 104 FFR CT 0 117 0 60 Dx Angio 153 37 9 10 PCI 44 5149

7. Costs Over 90 Days

8. Sensitivity Analysis  No Medicare cost-weight yet for FFR CT Primary analysis used $0 to estimate cost offsets Multiples of CTA cost weight in sensitivity analysis ScenarioUsual CareFFR CT P Invasive 0 x CTA$10,734$7,343<0.0001 7 x CTA$10,734$8,619<0.0001 Non-Invasive 0 x CTA$ 2,137$2,679 0.26 0.5 x CTA$ 2,137$2,766 0.02

9. Changes in SAQ, Baseline to 90 Days

10. Limitations  Not randomized or blinded  Conducted in Europe, not in the US  Only Medicare price weights used

11. Conclusions  In symptomatic patients with intermediate probability of CAD, evaluation strategies based on FFR CT had Lower cost than invasive coronary angiography Greater improvement in QOL than usual non-invasive testing

12. Published today in J Am Coll Cardiol