Thirty-Month Outcome After Fractional Flow Reserve–Guided Versus Conventional Multivessel Percutaneous Coronary Intervention

Wongpraparut, Nattawut; Yalamanchili, Vankata; Pasnoori, Venkat; Satran, Aaron; Chandra, Mukul; Masden, Ronald; Leesar, Massoud A.

doi:10.1016/j.amjcard.2005.05.040

Cited by 79 publications

(49 citation statements)

References 18 publications

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“…18 In a nonrandomized, single-center study of 137 patients with multivessel CAD, costs were lower and outcomes were better in the 57 patients who had FFR-guided PCI compared with the 80 patients with angiography-guided PCI. 19 Based on its large size, multicenter nature, and randomized prospective design, the present study further strengthens the evidence supporting the health economic advantage to measuring FFR to guide PCI.…”

Section: Fearon Et Al Cost-effectiveness Of Ffrsupporting

confidence: 50%

Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

et al. 2010

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Background-The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study demonstrated significantly improved health outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention guided by fractional flow reserve (FFR) compared with percutaneous coronary intervention guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known. Methods and Results-In this study, 1005 patients were randomly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years was performed with a time horizon of 1 year. Quality-adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up. Confidence intervals for both quality-adjusted life-years and costs were estimated by the bootstrap percentile method. Major adverse cardiac events at 1 year occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angiography-guided arm (Pϭ0.02). Quality-adjusted life-years were slightly greater in the FFR-guided arm (0.853 versus 0.838; Pϭ0.2). Mean overall costs at 1 year were significantly less in the FFR-guided arm ($14 315 versus $16 700; PϽ0.001). Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 90.74% and cost-effective at a threshold of US $50 000 per quality-adjusted life-years in 99.96%. Sensitivity analyses demonstrated robust results. Conclusion-Economic evaluation of the FAME study reveals that FFR-guided percutaneous coronary intervention in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves resources. Clinical Trial Registration-URL: http://ClinicalTrials.gov.

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Section: Fearon Et Al Cost-effectiveness Of Ffrsupporting

confidence: 50%

Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

et al. 2010

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“…Therefore, in patients with multivessel disease the use of FFR reduced the composite rate of death, myocardial infarction, and repeat revascularization at 1 year [13]. Retrospective studies have supported similar findings with FFR guided PCI resulting in better survival rates in patients who have multivessel coronary artery disease [14,15].…”

Section: Discussionsupporting

confidence: 62%

Pressure Wire Assessment in Patients with An Acute Coronary Syndrome

Rashid¹

2017

Interv Cardiol J

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Patients with stable coronary artery disease with a fractional flow reserve (FFR) of >0.75 to 0.8 can be safely managed with medical therapy with lower major adverse cardiac events. This avoids the risks associated with percutaneous coronary intervention (PCI) including stent thrombosis and restenosis. In patients with an acute coronary syndrome (ACS) the value of FFR is unclear as maximal hyperemia is required. In patients with an ACS microvascular changes may prevent vasodilatation thus affecting the validity of FFR. Studies have shown that FFR can be safely performed with high accuracy if performed a few days after an infarct.

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“…After reviewing the full texts of the remaining 26 articles, 19 were excluded and the reasons for exclusion are shown in Figure 1A. A total of seven articles were included in the meta-analysis [8,11,[15][16][17][18][19]. Abbreviations: RCT = randomized controlled trials; CAD = coronary artery diseases; PCI = percutaneous coronary intervention; FFR = fractional flow reserve; and, Angio = angiography.…”

Section: Literature Searchmentioning

confidence: 99%

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

Xiu¹,

Chen²,

Zheng³

et al. 2016

CIM

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*Contributed equally to this work.Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis Methods: Prospective and retrospective studies comparing FFR-guided vs. angiography-guided PCI in patients with multi-vessel CAD were identified from medical databases by two independent reviewers using the terms "percutaneous coronary intervention, fractional flow reserve, angiography, coronary heart disease, major adverse cardiac events (MACE) and myocardial infarction". The primary outcome was the number of stents placed, and the secondary outcomes were procedure time, mortality, myocardial infarction (MI) and MACE rates.Results: Seven studies (three retrospective and four prospective), which included 49,517 patients, were included in this review. A total of 4,755 patients underwent FFR, while 44,697 received angiography-guided PCI. The mean patient age ranged from 58 to 71.7 years. The average number of stents used in FFR patients ranged from 0.3-1.9, and in angiography-guided PCI patients ranged from 0.7-2.7. Analysis indicated there was a greater number of stents placed in the angiography-guided group compared with the FFR group (pooled difference in means: -0.64, 95% confidence interval [CI]: -0.81 to -0.47, P < 0.001). There were no differences in the secondary outcomes between the two groups.Conclusions: Both procedures produce similar clinical outcomes, but the fewer number of stents used with FFR may have clinical as was as cost implications.

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Thirty-Month Outcome After Fractional Flow Reserve–Guided Versus Conventional Multivessel Percutaneous Coronary Intervention

Cited by 79 publications

References 18 publications

Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

Pressure Wire Assessment in Patients with An Acute Coronary Syndrome

Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis

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