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

医学 部分流量储备 心肌梗塞 传统PCI 经皮冠状动脉介入治疗 心脏病学 内科学 罪魁祸首 血管成形术 临床终点 冠状动脉疾病 冲程(发动机) 随机对照试验 冠状动脉造影 机械工程 工程类
作者
Pieter C. Smits,Pietro Laforgia,Mohamed Abdel‐Wahab,Franz–Josef Neumann,Gert Richardt,Bianca M. Boxma‐de Klerk,Ketil Lunde,Carl E. Schotborgh,Zsolt Piróth,David Hořák,Adrian Włodarczak,Geert Frederix,Elmir Ömerovic
出处
期刊:Eurointervention [European Association of Percutaneous Cardiovascular Interventions]
卷期号:16 (3): 225-232 被引量:34
标识
DOI:10.4244/eij-d-20-00012
摘要

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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