Loading ...

TOPLINE:

Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) of non-infarct-related arteries (IRAs) saved medical costs and offered better quality of life than angiography-guided PCI in patients with acute myocardial infarction (AMI) and multivessel disease.

METHODOLOGY:

• This prespecified analysis of the FRAME-AMI trial compared the cost-effectiveness of FFR-guided PCI with that of angiography-guided PCI for non-IRA lesions in patients with AMI and multivessel disease. The main FRAME-AMI results showed FFR-guided PCI was superior on the primary endpoint of death, myocardial infarction, or repeat revascularization.
• The trial included 562 patients (mean age, 63.3 years; 84.3% men) with ST-segment elevation myocardial infarction (STEMI) or non-STEMI who underwent successful primary or urgent PCI and had at least one non-IRA lesion.
• Patients were randomly assigned to receive either FFR-guided PCI (n = 284) or angiography-guided PCI (n = 278).
• The main outcomes for this analysis were quality-adjusted life-years, direct medical costs, incremental cost-effectiveness ratio, and incremental net monetary benefit of FFR-guided PCI compared with angiography-guided PCI.

TAKEAWAY:

• At 4 years, FFR-guided PCI increased quality-adjusted life years by 0.06 compared with angiography-guided PCI.
• The total cumulative cost per patient in the FFR-guided PCI group was estimated to be $1208 less than that in the angiography-guided PCI group.
• The incremental cost-effectiveness ratio was −$19,484 and the incremental net monetary benefit was $3378 with the FFR-guided PCI strategy, suggesting that it was more cost-effective than angiography-guided PCI in these patients.
• FFR-guided PCI was also the more cost-effective strategy in the Korean, the United States, and European healthcare systems, with incremental net monetary benefits of $3910, $8557, and $2210, respectively.

IN PRACTICE:

"Fractional flow reserve-guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients," the authors concluded.

In an accompanying editorial, Rushi V. Parikh, MD, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, wrote, "These cost-effectiveness data are an important addition to the mixed body of evidence in this domain and may tip the scales toward adoption of an FFR-based strategy to achieve complete revascularization and combat rising costs in AMI."

SOURCE:

Corresponding authors were Danbee Kang, PhD, Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, and Joo Myung Lee, MD, MPH, PhD, Department of Internal Medicine and Cardiovascular Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, South Korea. The study was published online on January 25, 2024, in JAMA Network Open.

LIMITATIONS:

The outcomes of the cost-effectiveness analysis depended on variables that had been obtained through limited earlier studies. The trial had to be terminated earlier than planned due to the COVID-19 pandemic. The cost-effectiveness of the FFR-based approach may have been diluted because around 20% of patients randomized to the FFR group had very severe non-IRA lesions and went on to have PCI without FFR interrogation.

DISCLOSURES:

The trial received funding from Medtronic, Biotronik, Chong Kun Dang Pharmaceutical, and JW Pharmaceutical. Gwon, Hahn, and Lee declared receiving research grants from various sources.