FFR-Guided PCI Costs 30% Less Than Surgery for 3-Vessel Disease

Determining the optimal revascularization strategy for patients with multivessel coronary artery disease remains a central challenge in clinical cardiology. Historical meta-analyses involving 13,592 patients have frequently favored coronary artery bypass grafting, which demonstrated a 25 percent lower risk of myocardial infarction (Risk Ratio 0.75; 95 percent Confidence Interval, 0.58 to 0.96) compared to percutaneous coronary intervention [1, 2]. In diabetic cohorts, surgical approaches provide a significant survival advantage (Risk Ratio 1.51 for death with percutaneous intervention), though this benefit is balanced against a higher perioperative stroke risk (2.3 percent for stenting versus 3.8 percent for surgery) [3, 4]. While the use of second-generation everolimus-eluting stents has improved outcomes, percutaneous approaches still correlate with higher rates of major adverse cardiovascular events at long-term follow-up (Hazard Ratio 1.47; P=0.04) [5, 6]. A new analysis of the FAME 3 trial now examines whether fractional flow reserve-guided intervention (a physiological assessment using pressure wires to measure blood flow across a stenosis) can improve the long-term economic value of stenting, which previously demonstrated 30 percent lower cumulative costs while maintaining equivalent quality-adjusted life-years (a standard metric combining survival time with health-related quality of life) [7].