Does fractional flow reserve-guided PCI plus medical therapy improve clinical outcomes and cost-effectiveness compared to medical therapy alone in patients with stable coronary artery disease with reduced fractional flow reserve?
FFR-guided PCI is economically attractive and improves long-term outcomes compared to medical therapy alone in patients with stable coronary artery disease.
BACKGROUND: Previous studies found that percutaneous coronary intervention (PCI) does not improve outcome compared with medical therapy (MT) in patients with stable coronary artery disease, but PCI was guided by angiography alone. FAME 2 trial (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) compared PCI guided by fractional flow reserve with best MT in patients with stable coronary artery disease to assess clinical outcomes and cost-effectiveness. METHODS: A total of 888 patients with stable single-vessel or multivessel coronary artery disease with reduced fractional flow reserve were randomly assigned to PCI plus MT (n=447) or MT alone (n=441). Major adverse cardiac events included death, myocardial infarction, and urgent revascularization. Costs were calculated on the basis of resource use and Medicare reimbursement rates. Changes in quality-adjusted life-years were assessed with utilities determined by the European Quality of Life-5 Dimensions health survey at baseline and over follow-up. RESULTS: =0. 94). The incremental cost-effectiveness ratio for PCI compared with MT was 17 300 per quality-adjusted life-year at 2 years and 1600 per quality-adjusted life-year at 3 years. The above findings were robust in sensitivity analyses. CONCLUSIONS: PCI of lesions with reduced fractional flow reserve improves long-term outcome and is economically attractive compared with MT alone in patients with stable coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https: //www. clinicaltrials. gov. Unique identifier: NCT01132495.
Fearon et al. (2017) studied this question.