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

Abstract

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