The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Fractional flow reserve-guided multivessel angioplasty in myocardial infarction: three-year follow-up with cost benefit analysis of the Compare-Acute trial

EuroIntervention 2020;16:225-232. DOI: 10.4244/EIJ-D-20-00012

1. Department of Cardiology, Maastad Ziekenhuis, Rotterdam, the Netherlands; 2. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; 3. Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 4. Department of Cardiology, Segeberger Kliniken, Bad Segeberg, Germany; 5. Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 6. Department of Cardiology, Haga Ziekenhuis, Den Haag, the Netherlands; 7. Department of Cardiology, György Hungarian Institute of Cardiology, Budapest, Hungary; 8. University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic; 9. Department of Cardiology, Miedziowe Centrum Zdrowia Lubin, Poland; 10. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; 11. Department of Cardiology, Gothenburg University Hospital, Gothenburg, Sweden

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 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.

Visual summary. Three-year follow-up of FFR-guided complete revascularisation versus IRA-only strategy in patients with STEMI and multivessel disease.

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