Routine Use of Pressure Wire as an Adjunct to Diagnostic Angiography; Comparison of Resources Utilization in the Catheterization Laboratory: A Sub-Study of RIPCORD 2

Abstract

Background: The RIPCORD 2 trial randomized patients undergoing coronary angiography to strategy of routine measurement of fractional flow reserve (FFR) in all vessels or to angiography alone. Objectives: We compared, for the randomized groups, the catheter laboratory procedure costs to diagnosis. Methods: This is a sub-study of the RIPCORD2 trial. We excluded patients with follow-on PCI to better reflect procedural costs of the diagnostic phase.  We compared resource utilization and, from this, derived an estimated procedure cost for UK practice.  We examined the association between cost and the number of vessels examined with pressure wire (PW) technology. Results: We included 249/552 (45%) patients randomized to angiography and 261/548 (48%) patients to systematic FFR measurement.  The median (IQR) procedure cost was higher in the FFR group £1392 (1126 – 1686) versus £411 (308 – 586); P < 0.001. In the FFR group, 86.6% of procedures were completed with a single pressure wire; two and three PWs were used in 10.7% and 1.5% of cases respectively. The procedure duration (median, IQR; mins) was longer in the FFR group; 52 (39 – 66) versus 20 (15 – 30) as was the use of radiographic contrast (median, IQR; mls); 140 (110 – 189) versus 70 (60 – 94). In the FFR group, it seems that the additional cost was associated with the cost of the PW and laboratory set up for the performance of FFR measurement; the incremental cost of examining additional vessels, beyond the first, was modest. Conclusion: The procedural cost associated with a strategy of systematic measurement of FFR in all vessels is higher than that of angiography alone.