Cost-Effectiveness of Fractional Flow Reserve-Guided Treatment for Acute Myocardial Infarction and Multivessel Disease

被引：7

作者：

Hong, David ^{[5
]}

Lee, Seung Hun ^{[6
]}

Lee, Jin ^{[7
,8
]}

Lee, Hankil ^{[9
]}

Shin, Doosup ^{[10
]}

Kim, Hyun Kuk ^{[11
]}

Park, Keun Ho ^{[11
]}

Choo, Eun Ho ^{[12
]}

Kim, Chan Joon ^{[13
]}

Kim, Min Chul ^{[6
]}

Hong, Young Joon ^{[6
]}

Jeong, Myung Ho ^{[6
]}

Ahn, Sung Gyun ^{[14
]}

Doh, Joon-Hyung ^{[15
]}

Lee, Sang Yeub ^{[16
]}

Park, Sang Don ^{[13
,17
]}

Lee, Hyun-Jong ^{[18
]}

Kang, Min Gyu ^{[19
]}

Koh, Jin-Sin ^{[19
]}

Cho, Yun-Kyeong ^{[20
]}

Nam, Chang-Wook ^{[20
]}

Choi, Ki Hong ^{[5
]}

Park, Taek Kyu ^{[5
]}

Yang, Jeong Hoon ^{[5
]}

Song, Young Bin ^{[5
]}

Choi, Seung-Hyuk ^{[5
]}

Gwon, Hyeon-Cheol ^{[5
]}

Guallar, Eliseo ^{[21
]}

Cho, Juhee ^{[7
,8
]}

Hahn, Joo-Yong ^{[5
]}

Kang, Danbee ^{[1
,2
,7
,8
]}

Lee, Joo Myung ^{[3
,4
,5
]}

机构：

[1] Sungkyunkwan Univ, Samsung Adv Inst Hlth Sci & Technol, Dept Clin Res Design & Evaluat, 115 Irwon Ro, Seoul 06335, South Korea

[2] Samsung Med Ctr, Ctr Clin Epidemiol, 115 Irwon Ro, Seoul 06335, South Korea

[3] Samsung Med Ctr, Heart Vasc Stroke Inst, Dept Internal Med, 50 Irwon Dong, Seoul 135710, South Korea

[4] Samsung Med Ctr, Heart Vasc Stroke Inst, Cardiovasc Ctr, 50 Irwon Dong, Seoul 135710, South Korea

[5] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Heart Vasc Stroke Inst, Seoul, South Korea

[6] Chonnam Natl Univ Hosp, Gwangju, South Korea

[7] Sungkyunkwan Univ, Ctr Clin Epidemiol, Samsung Med Ctr, Seoul, South Korea

[8] Sungkyunkwan Univ, Samsung Adv Inst Hlth Sci & Technol, Dept Clin Res Design & Evaluat, Seoul, South Korea

[9] Ajou Univ, Coll Pharm, Suwon, South Korea

[10] Duke Univ, Med Ctr, Dept Internal Med, Div Cardiol, Durham, NC USA

[11] Univ Chosun, Chosun Univ Hosp, Coll Med, Gwangju, South Korea

[12] Catholic Univ Korea, Seoul St Marys Hosp, Seoul, South Korea

[13] Catholic Univ Korea, Uijeongbu St Marys Hosp, Seoul, South Korea

[14] Yonsei Univ, Wonju Severance Christian Hosp, Wonju Coll Med, Wonju, Afghanistan

[15] Inje Univ, Ilsan Paik Hosp, Dept Med, Goyang, South Korea

[16] Chung Ang Univ, Gwangmyeong Hosp, Coll Med, Gwangmyeong, South Korea

[17] Inha Univ Hosp, Incheon, South Korea

[18] Sejong Gen Hosp, Bucheon, South Korea

[19] Gyeongsang Natl Univ, Gyeongsang Natl Univ Hosp, Sch Med, Jinju, South Korea

[20] Keimyung Univ, Dongsan Med Ctr, Daegu, South Korea

[21] Johns Hopkins Med Inst, Welch Ctr Prevent Epidemiol & Clin Res, Dept Epidemiol & Med, Baltimore, MD USA

来源：

JAMA NETWORK OPEN | 2024年 / 7卷 / 01期

关键词：

PERCUTANEOUS CORONARY INTERVENTION; 3-YEAR FOLLOW-UP; ECONOMIC-EVALUATION; RANDOMIZED-TRIAL; ONLY REVASCULARIZATION; CLINICAL-OUTCOMES; ARTERY-DISEASE; LESION; ANGIOPLASTY; ANGIOGRAPHY;

D O I：

10.1001/jamanetworkopen.2023.52427

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Importance Complete revascularization by non-infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acute myocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)-guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective. Objective To evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acute myocardial infarction and multivessel disease. Design, Setting, and Participants In this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevation myocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis >50% in a major epicardial coronary artery or major side branch with a vessel diameter of >= 2.0 mm). Data analysis was performed on August 27, 2023. Intervention Fractional flow reserve-guided vs angiography-guided PCI for non-IRA lesions. Main Outcomes and Measures The model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5% per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials. Results The FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve-guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was -$19 484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCI was 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively. Conclusions and Relevance This cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve-guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients.

引用

页数：14