Fractional flow reserve-guided multivessel angioplasty in myocardial infarction: three-year follow-up with cost benefit analysis of the Compare-Acute trial.
EuroIntervention
; 16(3): 225-232, 2020 Jun 25.
Article
em En
| MEDLINE
| ID: mdl-32250250
ABSTRACT
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 ANDRESULTS:
After primary percutaneous coronary intervention (PCI), 885 patients with STEMI and MVD were randomised (12 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.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Angioplastia
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Reserva Fracionada de Fluxo Miocárdico
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Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Infarto do Miocárdio
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article