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Coronary artery disease management and cost implications with fractional flow reserve guided coronary intervention in Indian patients with stable ischemic coronary artery disease
Author(s) -
Thomson Viji S.,
Varghese Mithun J.,
Chacko Sujith T.,
Varghese Lijo,
Alex Anoop G.,
George Paul V.,
George Oommen K.,
Joseph George,
Yadav Bijesh K.,
John Jacob
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28897
Subject(s) - medicine , fractional flow reserve , percutaneous coronary intervention , cardiology , mace , conventional pci , stent , coronary artery disease , myocardial infarction , revascularization , coronary angiography
Objectives To study the safety of stent avoidance, frequency of change in management decisions, and its cost implications while using a fractional flow reserve (FFR)‐guided treatment strategy for intermediate‐grade coronary artery stenosis. Background The impact of FFR in guiding management decisions and its cost implications has not been studied after imposition of a ceiling on stent prices by the Government of India. Methods In 400 patients with 477 intermediate‐grade coronary lesions for whom coronary intervention was planned, functional assessment using FFR was done. Incidence of the primary composite endpoint (major adverse cardiac event [MACE], cardiac death, myocardial infarction, objective evidence of ischemia, and target vessel revascularization) in the stent avoided subset was compared with the stented group at follow‐up. Micro‐costing analysis was done using a computed model with current stent and FFR wire prices. Results The overall incidence of MACE was 4.9%, 0.9% in the stent‐avoided subset and 6.9% in stented group ( p = 0.04, comparing the latter two) at a median follow‐up of 21 months (interquartile range 12–31 months). Serious adverse events occurred only in 1% of patients receiving adenosine. The average cost saving was Indian rupees (INR) 51,847 [United States Dollar (USD) 746] per patient, resulting in total savings of INR 15,813,379 (USD 227,530). Cost savings persisted but were lower by 36% (INR 18,613/USD 268 per patient) after the ceiling of stent prices. Conclusion FFR‐guided percutaneous coronary intervention (PCI) strategy is safe and cost‐effective in countries where majority of patients self‐finance their health care, resulting in stent and PCI avoidance in approximately one in three patients referred for coronary angioplasty.