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

The France PCI registry: Design, methodology and key findings

BACKGROUND

Obstructive coronary artery disease is the main cause of death worldwide. By tracking events and gaining feedback on patient management, the most relevant information is provided to public health services to further improve prognosis.

AIMS

To create an inclusive and accurate registry of all percutaneous coronary intervention (PCI) procedures performed in France, to assess and improve the quality of care and create research incentives. Also, to describe the methodology of this French national registry of interventional cardiology, and present early key findings.

METHODS

The France PCI registry is a multicentre observational registry that includes consecutive patients undergoing coronary angiography and/or PCI. The registry was set up to provide online data analysis and structured reports of PCI activity, including process of care measures and assessment of risk-adjusted outcomes in all French PCI centres that are willing to participate. More than 150 baseline data items, describing demographic status, PCI indications and techniques, and in-hospital and 1-year outcomes, are captured into local reporting software by medical doctors and local research technicians, with subsequent encryption and internet transfer to central data servers. Annual activity reports and scoring tools available on the France PCI website enable users to benchmark and improve clinical practices. External validation and consistency assessments are performed, with feedback of data completeness to centres.

RESULTS

Between 01 January 2014 and 31 December 2022, participating centres increased from six to 47, and collected 364,770 invasive coronary angiograms and 176,030 PCIs, including 54,049 non-ST-segment elevation myocardial infarction cases and 31,631 ST-segment elevation myocardial infarction cases. Fifteen studies stemming from the France PCI registry have already been published.

CONCLUSIONS

This fully electronic, daily updated, high-quality, low-cost, national registry is sustainable, and is now expanding. Merging with medicoeconomic databases and nested randomized scientific studies are ongoing steps to expand its scientific potential.

Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1

Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.

Long-Term Cost-Effectiveness of Fractional Flow Reserve-Based Percutaneous Coronary Intervention in Stable and Unstable Angina

Background

There are limited studies on the cost-effectiveness of fractional flow reserve (FFR)-based percutaneous coronary intervention (PCI) over angiography-based PCI.

Objectives

The current study sought to evaluate long-term cost-effectiveness of FFR-based PCI compared to angiography-based PCI.

Methods

A cost-effectiveness analysis was conducted using a nationwide cohort that consisted of patients with stable or unstable angina from the National Health Insurance Service (NHIS) and Health Insurance Review and Assessment (HIRA) database in Korea. The cost-effectiveness analysis was also performed by using a decision and Markov model with key values from the United States and the United Kingdom health care systems. Incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life-years gained by FFR-based PCI, was evaluated.

Results

In the NHIS-HIRA data, FFR-based PCI was used during the index PCI in 5,116 patients (3.8%) among 134,613 eligible patients. FFR-based PCI showed significantly lower risk of all-cause death (5.8% vs 7.7%, P = 0.001) and spontaneous myocardial infarction (1.6% vs 2.2%, P = 0.022) than the angiography-based PCI at 4 years. In the NHIS-HIRA data, FFR-based PCI gained 0.039 quality-adjusted life-years at a lower cost ($303) than angiography-based PCI, yielding an ICER of -$7,748 during the 4-year follow-up. FFR-based PCI was dominant in the health care system of Korea (ICER = -$7,309), United States (ICER = -$31,267), and United Kingdom (ICER = -$1,341) during a 10-year time horizon. These results were consistently shown in probabilistic sensitivity analyses.

Conclusions

In the current cohort, FFR-based PCI was associated with higher quality of life at a lower cost than angiography-based PCI. FFR-based PCI was cost-effective in patients with stable or unstable angina undergoing PCI.