In a recent analysis of the FRAME-AMI trial, researchers found that the use of fractional flow reserve (FFR) guidance for nonculprit lesion intervention in patients with acute myocardial infarction (MI) resulted in cost savings and increased quality of life. The study demonstrated that FFR increased quality-adjusted life-years (QALYs) by 0.06 compared to angiography-guided percutaneous coronary intervention (PCI) of non-culprit lesions, while also reducing cumulative costs by $1,208 per patient. These findings indicate that FFR is more cost-effective for patients with acute MI and multivessel disease, and can potentially improve patient prognosis in the long term.
The study’s results showed that FFR guidance was consistently more cost-effective across various subgroups and healthcare systems, including those in the United States, Korea, and Europe. The use of routine angiography-guided PCI for all non-infarct-related artery (IRA) lesions with diameter stenosis greater than 50% was deemed unnecessary and potentially harmful, as it often led to unnecessary procedures, additional stents, increased contrast media use, and higher risk of complications. In contrast, FFR-guided PCI allowed for the identification of functionally insignificant stenosis and reduced the need for unnecessary interventions. Therefore, FFR-guided PCI is considered superior for patients with stable ischemic heart disease as well as those with acute MI and multivessel disease.
The main results of the FRAME-AMI trial strongly supported the use of FFR guidance in deciding which nonculprit lesions to treat in patients with acute MI. In comparison to the FLOWER-MI trial, which found no superiority of FFR over angiographic guidance, the FRAME-AMI trial demonstrated that FFR-guided PCI resulted in lower rates of non-IRA PCI and comparable clinical outcomes. The researchers noted that deferral of PCI for non-IRA lesions based on FFR provided similar or even superior clinical outcomes compared to angiography-guided PCI. This highlights the potential of FFR to save medical resources and costs without compromising patient safety.
The cost-effectiveness data from the FRAME-AMI trial are crucial in guiding the adoption of an FFR-based strategy for complete revascularization in acute MI. These findings may help address the rising costs associated with MI treatment and inform future healthcare policies. However, larger trials powered for hard outcomes are necessary to further validate the preferred strategy in this evolving clinical paradigm. The consistent cost-effectiveness of FFR-guided complete revascularization across different healthcare systems is particularly noteworthy and underscores the potential benefits of this approach.
It is important to acknowledge the limitations of the FRAME-AMI trial and its cost-effectiveness analysis. The study relied on limited country-level healthcare system data, which may not fully reflect the complexities and variations in real-world practice. Additionally, the trial was stopped early due to the COVID-19 pandemic, which may have impacted certain aspects of the study. Future research should consider these limitations and aim to gather more comprehensive data to strengthen the evidence for FFR-guided PCI in acute MI.
The use of FFR guidance in nonculprit lesion intervention for patients with acute MI and multivessel disease has been shown to be cost-effective and improve quality of life. By reducing unnecessary procedures and interventions, FFR-guided PCI offers potential cost savings while maintaining clinical outcomes. These findings support the adoption of an FFR-based strategy for complete revascularization in acute MI and highlight the need for further research in this area. With ongoing trials such as FULL REVASC, OPTION-STEMI, and COMPLETE 2, future studies will provide additional insights into the effectiveness and safety of FFR-guided intervention in acute MI.
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