The Cost-Effectiveness of Fractional Flow Reserve (FFR) Guidance in Acute Myocardial Infarction

Fractional Flow Reserve (FFR) guidance has emerged as a potential solution for improving the outcomes and reducing costs in patients with acute myocardial infarction (MI) requiring complete revascularization. A recent analysis of the FRAME-AMI trial has demonstrated that FFR-guided percutaneous coronary intervention (PCI) for nonculprit lesions can increase quality-adjusted life-years (QALYs) and reduce costs compared to angiography-guided PCI. This finding holds true across various healthcare systems and subgroups, making FFR a cost-effective strategy for patients with acute MI and multivessel disease.

The study conducted by Joo Myung Lee and his team suggests that routine angiography-guided PCI for non-infarct related artery (non-IRA) lesions may lead to unnecessary procedures, additional stents, and increased risk of complications. This approach, even without inducible myocardial ischemia, may not improve long-term patient prognosis. Therefore, FFR-guided PCI offers a potential solution by reducing unnecessary interventions for functionally insignificant stenosis and providing better outcomes for patients with stable ischemic heart disease and acute MI.

Contrasting Results and the Role of FFR Guidance

The main results of the FRAME-AMI trial support the use of FFR guidance for nonculprit lesion intervention in patients with acute MI. This is in contrast to the FLOWER-MI trial, which did not find FFR to be superior to angiographic guidance. The FRAME-AMI trial showed that FFR-guided PCI resulted in significantly lower rates of non-IRA PCI compared to angiography-guided PCI, with comparable or superior clinical outcomes. As such, FFR guidance can not only improve patient outcomes but also save medical resources and costs without compromising safety.

Cost-Effectiveness and Future Implications

The cost-effectiveness of FFR-guided complete revascularization in acute MI is a crucial aspect of its adoption as a clinical strategy. The analysis of the FRAME-AMI trial shows that FFR guidance is a cost-effective approach, resulting in incremental net monetary benefit and lower cumulative total costs per patient compared to angiography-guided PCI. These findings are consistent across different healthcare systems and should inform future policies.

The analysis included 562 patients with acute MI and multivessel disease from the FRAME-AMI trial. The participants had an average age of 63.3 years, and the majority were men. While the study demonstrated the cost-effectiveness of FFR guidance in this population, it excluded patients with left main coronary artery disease or chronic total occlusion in non-IRA lesions. Therefore, the applicability of FFR-guided PCI to these patient groups remains unknown.

Fractional Flow Reserve (FFR) guidance offers a cost-effective solution for nonculprit lesion intervention in patients with acute myocardial infarction (MI) and multivessel disease. The analysis of the FRAME-AMI trial demonstrates that FFR-guided percutaneous coronary intervention (PCI) improves quality-adjusted life-years (QALYs) and reduces costs compared to angiography-guided PCI. This finding holds true across different healthcare systems and subgroups, suggesting that FFR guidance should be considered as a preferred strategy for complete revascularization. However, further research and larger trials are needed to fully establish the superiority of FFR over angiography in achieving complete revascularization and improving clinical outcomes in acute MI.

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