Prognosis and Medical Cost of Measuring Fractional Flow Reserve in Percutaneous Coronary Intervention

David Hong; Seung Hun Lee; Doosup Shin; Ki Hong Choi; Hyun Kuk Kim; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Seung-Hyuk Choi; Hyeon-Cheol Gwon; Joo Myung Lee

doi:10.1016/j.jacasi.2022.04.006

Prognosis and Medical Cost of Measuring Fractional Flow Reserve in Percutaneous Coronary Intervention

JACC Asia. 2022 Jul 19;2(5):590-603. doi: 10.1016/j.jacasi.2022.04.006. eCollection 2022 Oct.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
² Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
⁴ Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Republic of Korea.

Abstract

Background: There are limited data regarding comparative prognosis and medical cost between fractional flow reserve (FFR)-based and angiography-based percutaneous coronary intervention (PCI) among revascularized patients.

Objectives: This study evaluates prognosis and medical cost of FFR use in revascularized patients by PCI.

Methods: Using the National Health Insurance Service database, stable or unstable angina patients who underwent PCI from 2011 to 2017 were evaluated. Eligible patients were divided into 2 groups according to use of FFR in PCI. Primary outcome was a composite of all-cause death or spontaneous myocardial infarction (MI). Secondary outcomes included individual components of the primary outcome, unplanned revascularization, and medical costs.

Results: Among 134,613 eligible patients, PCI was performed based on angiography (n = 129,497) and FFR (n = 5,116). During the study period, both the annual number and proportion of use of FFR in PCI increased (all P for trend <0.001). The FFR group showed significantly lower risk of the primary outcome (7.0% vs 9.5%; P < 0.001), all-cause death (5.8% vs 7.7%; P = 0.001), and spontaneous MI (1.6% vs 2.2%; P = 0.022) than the angiography group. Although the FFR group showed higher medical cost during index admission than angiography group (median: $6,265.10 vs $5,385.60; P < 0.001), cumulative medical cost after index admission was significantly lower ($2,696.50 vs. $3,142.10; P < 0.001).

Conclusions: Use of FFR in PCI in stable or unstable angina patients showed significantly lower risk of all-cause death and spontaneous MI compared to angiography-based PCI. Although the FFR group had higher initial medical cost than the angiography group, cumulative medical cost after index admission was significantly lower.

Keywords: CABG, coronary artery bypass graft; FFR, fractional flow reserve; IHD, ischemic heart disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; PS, propensity score; RCT, randomized controlled trial; fractional flow reserve; percutaneous coronary intervention; prognosis; stable ischemic heart disease; unstable angina.