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Clinical usefulness and cost effectiveness of fractional flow reserve among Indian patients (FIND study)
G Sengottuvelu1, Babu Chakravarthy2, Ravindran Rajendran3
1Senior Consultant and Interventional cardiologist, Department of cardiology, Apollo Hospitals, Greams Road, Chennai, Tamil Nadu, India.
Insights
Fractional flow reserve (FFR) guided management of intermediate coronary artery disease in Indians reduces stent usage and costs. This approach offers significant clinical and economic benefits for patients with severe coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Fractional flow reserve (FFR) offers advantages in managing coronary artery disease (CAD).
- Limited data exists on FFR utility in the Indian population, characterized by diffuse, small, and multivessel disease.
- FFR may provide significant cost and outcome benefits in this demographic.
Purpose of the Study:
- To evaluate the clinical utility, cost-effectiveness, and medium-term outcomes of FFR-based management for intermediate-severity CAD.
- To assess the impact of FFR on treatment decisions compared to angiography alone in Indian patients.
Main Methods:
- A retrospective analysis compared treatment decisions made by a treating cardiologist (using both FFR and angiogram data) with a reviewing cardiologist (using angiogram data only).
- Eighty-one vessels with intermediate lesions in 59 patients were analyzed.
Main Results:
- FFR-guided management led to 26 fewer stents being used for intermediate lesions.
- Angiography alone misclassified over 40% of intermediate lesions, highlighting the value of FFR.
- No major adverse events occurred during an average 11-month follow-up.
- FFR-based management resulted in a net cost saving of INR 8,57,600 (USD 15,600).
Conclusions:
- FFR-guided management is clinically and economically beneficial for Indian patients with intermediate coronary artery lesions.
- This strategy optimizes treatment decisions, reduces unnecessary interventions, and improves cost-effectiveness in CAD management.
Objectives:
To study the clinical usefulness, cost benefit, and medium term outcome of fractional flow reserve (FFR) based management of coronary artery disease of intermediate severity.
Background:
In spite of the advantages of FFR there is paucity of data in Indian population who have frequent diffuse, small and multivessel disease where it would probably be more beneficial in terms of cost and outcome.
Methods:
The treating cardiologist's management decision with both FFR and angiographic data was compared with that of a reviewing cardiologist decision based on a retrospective analysis of angiogram alone.
Results:
Eighty-one vessels with intermediate lesions in 59 patients required 26 stents lesser when FFR data was added to the angiogram. The concordance of management decision was about 58% which means that >40% of intermediate lesions would be misclassified as significant based on angiography alone. There were no major events at a mean follow up of 11 ± 5 months. The net cost benefit in favor of FFR based management was INR 8,57,600 (USD 15,600) in our centre.
Conclusion:
Indians with more severe form of CAD benefit from a FFR based management plan for intermediate lesions, both clinically and economically. © 2014 Wiley Periodicals, Inc.
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