COMPARE-ACUTE: FFR-Guided Non-Culprit Vessel Revascularization in Primary Angioplasty

Courtesy of the SBHCI.

About 50% of patients admitted with acute ST-segment elevation myocardial infarction also present lesions in another vessel. Whether to treat these or not, and the optimal moment to treat non-culprit infarction-related vessels are still controversial issues.

The COMPARE-ACUTE study was recently published and showed that fractional flow reserve (FFR)-guided complete functional revascularization is superior to revascularization of the culprit artery alone. Now, we have a cost analysis of this strategy.

The analysis included patients with acute ST-segment elevation myocardial infarction who underwent primary angioplasty. A segment was randomized to receive FFR-guided complete revascularization (n = 295) and the other was assigned to receive culprit artery treatment only (n = 590).

All non-culprit artery lesions over 50% were analyzed through FFR in all patients. In patients randomized to complete revascularization, the operator was informed of the result of the FFR; however, if the patient belonged to the control group, FFR results were blinded.

Complete revascularization could be performed during the index procedure or within 72 hours from primary angioplasty, if there were clinical reasons for postponement.

The combined endpoint of all-cause death, infarction, stroke, or any revascularization at 12 months took place in 7.8% of patients who received FFR-guided complete revascularization vs. 20.5% of patients in the control group (p < 0.001). The difference was basically driven by the rate of repeat revascularization (6.1% vs. 17.5%; p < 0.001).

In all countries in which the study was carried out, FFR-guided complete revascularization was almost 30% cheaper than treatment of the culprit vessel alone.

Conclusion

FFR-guided complete revascularization after primary angioplasty reduced the number of events when compared to treatment of the culprit vessel alone, and it also lowered costs, at least in the countries in which this study took place (United States, Poland, Sweden, Netherlands, and Germany).

Courtesy of the (SBHCI).

Original title: FFR-Guided Complete Revascularisation During Primary Angioplasty Is Cost-Saving: Results from the COMPARE-ACUTE Trial.

Presenter: Elmie Omerovi.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.