Author + information
Background: Fractional flow reserve (FFR) has proven to be an essential tool for direct physiologic measurement of the functional significance of an angiographic stenosis. The adoption, cost, and impact on readmission among patients undergoing percutaneous coronary intervention in current practice remains unclear.
Methods: We retrospectively analyzed discharge data for index admission, 30-day, and 6-month readmissions for patients undergoing percutaneous coronary transluminal angioplasty (PTCA) with FFR in the 2013 National Readmission Database (NRD) and Nationwide Inpatient Sample (NIS) Database using ICD-9 CM procedure codes. The NRD and NIS are all-payer inpatient databases with discharge data from 1,045 hospitals in the United States maintained by the Healthcare Cost and Utilization Project (HCUP). Mortality, readmission, and cost were evaluated using hierarchical linear model controlling for gender, age, insurance, and comorbidity measured by Charlson Index.
Results: There were 24,012 FFR procedures in 2013 with readmissions data; 13,212 (55%) received PTCA. Of the 479,384 patients who underwent PTCA from Jan. 2013 to Nov. 2013, 13,212 (2.7%) utilized FFR. Age, gender, Charlson comorbidity index (CI: 1.95 vs. 2.04) and income measured by zipcode were not significantly different between FFR guided PTCA and not. Those who received FFR were more like to be covered by Medicare (57.8% vs. 54.3%, P<0.001). The additional cost of FFR was marginal ($22,718 vs. $22,424 IRR: 1.04 P<0.02). While FFR guided PTCA patients had increased 30-day readmission (12.9% vs. 11.7% OR:1.09, P<0.03), there was no difference in 6-month readmission. Patients receiving FFR had lower mortality at discharge (0.71% vs. 2.3% OR: 0.31, p <0.001) and shorter length of stay (3.5 vs. 3.9 days, IRR: 0.91, P<0.001).
Conclusions: FFR is a valuable tool for physiologic assessment of coronary lesions. When used in conjunction with PTCA, FFR reduced length of stay with only a marginal greater cost, however, 30 day readmission rates for PTCA utilizing FFR were 9% higher than PTCA without FFR. Strikingly, PTCA utilizing FFR had over three times lower mortality at discharge than PTCA without FFR.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function
Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology
Presentation Number: 1115-180
- 2017 American College of Cardiology Foundation