Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction: 3-year follow-up with cost benefit analysis of the Compare-Acute trial
Pieter Smits1, ; Pietro L. Laforgia2, MD; Mohamed Abdel-Wahab3; Franz-Josef Neumann4; Gert Richardt5; Bianca Boxma-de Klerk6; Ketil Lunde7; Carl E. Schotborgh8; Zsolt Piroth9; David Horak10; Adrian Wlodarczak11; Geert W. Frederix12; Elmir Omerovic13; Paul J Ong14; Rainer Hambrecht15; Oskar Angeras16;
1. Department of Cardiology, Maastad Ziekenhuis, Rotterdam, The Netherlands, Netherlands 2. IRCCS Policlinico San Donato, Cardiologia Clinica, San Donato Milanese, Italy 3. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. 4. Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. 5. Department of Cardiology, Segeberger Kliniken, Bad Segeberg, Germany. 6. Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands. 7. Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway. 8. Department of Cardiology, Haga Ziekenhuis, Den Haag, The Netherlands. 9. Department of Cardiology, György Hungarian Institute of Cardiology, Budapest, Hungary. 10. University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic. 11. Department of Cardiology, Miedziowe Centrum Zdrowia Lubin, Poland. 12. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. 13. Department of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden. 14. Department of Cardiology, Tan Tock Seng Hospital, Singapore 15. Department of Cardiology, Klinikum Links der Weser, Bremen, Germany 16. Department of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden
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Aims The Compare-Acute trial showed superiority of fractional flow reserve (FFR)-guided acute complete revascularization compared to culprit-only treatment in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) at 1 year. The aim of this study is to investigate the outcome at 3 years, together with cost analysis of this strategy.
Methods and Results
After primary percutaneous coronary intervention (PCI), 885 patients with STEMI and MVD were randomized (1:2 ratio) towards FFR-guided complete revascularization (295 patients) or infarct-related artery (IRA)-only treatment (590 patients). After 36 months, the primary end-point (composite of death, myocardial infarction, revascularization, stroke) occurred significantly less frequently in the FFR-guided complete revascularization 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 mainly driven by the reduction of revascularizations 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 revascularization strategy, which can reduce the cost-per-patient up to 21% at 1 year (8.150€ in vs 10.319€) and by 22% at 3 years (8.653€ vs 11.100€).
In patients with STEMI and MVD, FFR-guided complete revascularization is more beneficial in terms of outcome and health-care costs compared to IRA-only revascularization at 36 months.