Fractional flow reserve-guided multivessel angioplasty in myocardial infarction: Three-year follow-up with cost benefit analysis of the Compare-Acute trial
Smits, Pieter C.; Laforgia, Pietro L.; Abdel-Wahab, Mohamed; Neumann, Franz Josef; Richardt, Gert; Boxma-De Klerk, Bianca; Lunde, Ketil; Schotborgh, Carl E.; Piroth, Zsolt; Horak, David; Wlodarczak, Adrian; Frederix, Geert W.; Omerovic, Elmir; Ong, Paul J.; Hambrecht, Rainer; Angeras, Oskar
(2020) EuroIntervention, volume 16, issue 3, pp. 225 - 232
(Article)
Abstract
AIMS: The Compare-Acute trial showed superiority of fractional flow reserve (FFR)-guided acute complete revascularisation compared to culprit-only treatment in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) at one year. The aim of this study was to investigate the outcome at three years, together with cost analysis
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of this strategy. METHODS AND RESULTS: After primary percutaneous coronary intervention (PCI), 885 patients with STEMI and MVD were randomised (1:2 ratio) to FFR-guided complete revascularisation (295 patients) or infarct-related artery (IRA)-only treatment (590 patients). After 36 months, the primary endpoint (composite of death, myocardial infarction, revascularisation, stroke) occurred significantly less frequently in the FFR-guided complete revascularisation group: 46/295 patients (15.6%) versus 178/590 patients (30.2%) (HR 0.46, 95% CI: 0.33-0.64; p<0.001). This benefit was driven mainly by the reduction of revascularisations in the follow-up (12.5% vs 25.2%; HR 0.45, 95% CI: 0.31-0.64; p<0.001). Cost analysis shows benefit of the FFR-guided complete revascularisation strategy, which can reduce the cost per patient by up to 21% at one year (8,150€ vs 10,319€) and by 22% at three years (8,653€ vs 11,100€). CONCLUSIONS: In patients with STEMI and MVD, FFR-guided complete revascularisation is more beneficial in terms of outcome and healthcare costs compared to IRA-only revascularisation at 36 months.
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Keywords: Angioplasty/economics, Coronary Angiography, Coronary Artery Disease/diagnosis, Cost-Benefit Analysis, Follow-Up Studies, Fractional Flow Reserve, Myocardial/physiology, Humans, Myocardial Infarction/economics, Percutaneous Coronary Intervention/economics, ST Elevation Myocardial Infarction, Treatment Outcome, Journal Article, Randomized Controlled Trial
ISSN: 1774-024X
Publisher: Europa Group
Note: Funding Information: This work was supported by Maasstad Cardiovascular Research BV, which received research grants from Abbott Vascular and St. Jude Medical. Funding Information: P.C. Smits reports grants from Abbott Vascular and St. Jude Medical during the conduct of the study. F-J. Neumann reports grants from Abbott Vascular, Medtronic, GlaxoSmithKline and St. Jude Medical during the conduct of the study, personal fees from Amgen, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Ferrer, The Medicines Company and Novartis, and grants and personal fees from Pfizer, Boston Scientific, Biotronik, Edwards Lifesciences and Bayer Healthcare, outside the submitted work. O. Angerås reports personal fees from Abbott Medical and Boston Scientific, outside the submitted work. G.W. Frederix received a fee from Abbott Vascular to perform the cost analysis. The other authors have no conflicts of interest to declare. Publisher Copyright: © Europa Digital & Publishing 2020. All rights reserved.
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