Complete Revascularization by non-IRA percutaneous coronary intervention is a common practice for improving patient prognosis in acute myocardial infarction. However, the cost-effectiveness of fractional flow reserve (FFR) guided versus angiography-guided non-IRA PCI treatment strategies remains uncertain.
The use of FFR-guided percutaneous coronary intervention (PCI) for non-IRA ( non–infarct-related artery) lesions was demonstrated to be more cost-effective, saving medical costs and improving life quality more effectively than angiography-guided PCI in individuals with acute myocardial infarction and multivessel disease, according to a recent JAMA study.
This study used data from the FRAME-AMI trial to compare the cost-effectiveness of FFR-guided and angiography-guided PCI in patients with acute MI and multivessel disease. The trial randomly allocated patients to FFR-guided or angiography-guided PCI for non-IRA lesions (August 19, 2016-December 24, 2020). Patients were aged 19 or older, had STEMI or non-STEMI, underwent successful primary or urgent PCI, and had at least one non-IRA lesion. The analysis was performed on August 27, 2023.
The study simulated death, MI and repeat Revascularization. Medical costs and benefits were discounted by 4.5% annually. The main outcomes included quality-adjusted life years, direct medical costs, incremental cost-effectiveness ratio, and incremental net monetary benefits of FFR-guided PCI compared to angiography-guided PCI. The researchers applied state-transition Markov models to the Korean, US, and European healthcare systems using medical costs (in US dollars), utility data, and transition probabilities from a meta-analysis of previous trials.
Key findings from the study are:
562 patients (mostly men) of 63.3 years were randomized.
• FFR–guided PCI increased QALYs by 0.06.
• The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared.
• The ICER and INB was −$19 484 and $3378. This indicates FFR-guided PCI is more cost-effective for acute MI patients and multivessel disease.
• Probabilistic sensitivity analysis showed consistent results. The likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%.
• FFR-guided PCI was cost-effective in Korean, US, and European systems with INBs of $3910, $8557, and $2210, respectively, based on FLOWER-MI and FRAME-AMI trial pairwise meta-analysis.
• The likelihood iteration of cost-effectiveness with FFR-guided PCI was 85% in the Korean, 82% in the US, and 31% in the European healthcare systems (probabilistic sensitivity analysis).
This analysis indicates that FFR-guided PCI for non-IRA lesions is a more cost-effective and higher-quality treatment option than angiography-guided PCI for patients with acute MI and multivessel disease.
FFR-guided PCI should be considered when deciding the treatment strategy for non-IRA stenoses.
Reference:
Hong D, Lee SH, Lee J, et al. Cost-Effectiveness of Fractional Flow Reserve–Guided Treatment for Acute Myocardial Infarction and Multivessel Disease: A Prespecified Analysis of the FRAME-AMI Randomized Clinical Trial. JAMA Netw Open. 2024;7(1):e2352427
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