{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:40:35Z","timestamp":1791232835375,"version":"4.1.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Complete revascularization by non\u2013infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acute myocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)\u2013guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acute myocardial infarction and multivessel disease.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevation myocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis &amp;gt;50% in a major epicardial coronary artery or major side branch with a vessel diameter of \u22652.0 mm). Data analysis was performed on August 27, 2023.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Fractional flow reserve\u2013guided vs angiography-guided PCI for non-IRA lesions.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5% per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials.<\/jats:p><\/jats:sec>Results<\/jats:title>The FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve\u2013guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was \u2212$19\u202f484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCI was 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve\u2013guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02715518<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.52427","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T11:33:32Z","timestamp":1706182412000},"page":"e2352427","source":"Crossref","is-referenced-by-count":10,"title":["Cost-Effectiveness of Fractional Flow Reserve\u2013Guided Treatment for Acute Myocardial Infarction and Multivessel Disease"],"prefix":"10.1001","volume":"7","author":[{"given":"David","family":"Hong","sequence":"first","affiliation":[{"name":"Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung 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