title: Measurement of myocardial fractional flow reserve is a cost-effective way to identify coronary artery lesions of indeterminate severity that warrant revascularisation.
abstract: BACKGROUND
  The RADI pressure wire may be used in stenotic coronary arteries to calculate myocardial fractional flow reserve (FFR(myo)), the ratio between distal hyperaemic coronary pressure and aortic pressure. A ratio less than 0.75 categorizes lesions of haemodynamic significance for which percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) may be warranted. We undertook this study to evaluate the cost implications of performing these measurements.
  
  
  METHODS
  We recorded FFR(myo) using RADI wires in 32 coronary artery lesions of between 30 and 60% diameter stenosis in 31 patients and assessed how this information changed our management.
  
  
  RESULTS
  We followed our original "management plan" in only eight patients. PCI or CABG was performed in eight whose lesions were characterised by a FFR(myo) value of 0.76 or less. Myocardial perfusion imaging (MPI) was done in only one of nine for whom this had seemed to be appropriate. Two-thirds of those for whom PCI had appeared to be warranted were treated conservatively and only one quarter of the original "surgical" group underwent CABG.
  
  
  CONCLUSIONS
  Although RADI pressure wires are an additional expense, it is appropriate to use them to assess coronary stenotic lesions of indeterminate severity. When we took into account the savings that arose from changes in management, the additional cost of measuring FFR(myo) was around dollar 580 per study.
authors.affiliation: CHL-Apollo Hospital, Indore, M.P. 452-008, India.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Trivedi
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Aroney
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.forename: John Hugh Nicholas
authors.initials: JH
authors.lastname: Bett
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001011:Aorta / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000191:economics* / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D017725:Ventricular Pressure / Q000502:physiology*