title: Fame comes at a cost: a Canadian analysis of procedural costs in use of pressure wire to guide multivessel percutaneous coronary intervention.
abstract: The FAME-study authors claimed that fractional flow reserve (FFR)-guided multivessel percutaneous coronary intervention (PCI) achieved superior clinical outcome and lower cost compared with no FFR. However, patients were intended to undergo multivessel PCI with drug eluting stents prior to randomization, which tipped the cost-analysis heavily in favour of FFR. We retrospectively evaluated 100 intermediate coronary lesions assessed by FFR, and determined whether to perform PCI based on visual angiographic assessment alone. We found that angiographic-guided treatment underestimated functional significance of intermediate lesions, resulting in fewer implanted stents compared to FFR guidance. This, in addition to the pressure wire cost, increased procedural expenditure 2- to 3-fold when using FFR-guidance.
authors: Vancouver General Hospital, Vancouver, British Columbia, Canada.
authors: Stephen P
authors: SP
authors: Hoole
authors: Michael D
authors: MD
authors: Seddon
authors: Rohan S
authors: RS
authors: Poulter
authors: G B John
authors: GB
authors: Mancini
authors: David A
authors: DA
authors: Wood
authors: Jacqueline
authors: J
authors: Saw
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000295:instrumentation; D002170:Canada; D017023:Coronary Angiography / Q000191:economics; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D003365:Costs and Cost Analysis; D004867:Equipment Design; D053805:Fractional Flow Reserve, Myocardial; D017048:Health Care Costs; D006801:Humans; D011312:Pressure