One-year clinical outcomes and relative costs of primary infarct artery stenting versus angioplasty following systemic thrombolysis for acute myocardial infarction

• Published in: Catheterization and cardiovascular interventions 2000-02, Vol.49 (2), p.135-141
• Main Authors: Rocha-Singh, Krishna J., McShane, Karen J., Ligon, Robert, Sung, Chung-Hsien
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - economics; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Female; Heart; Hospital Costs; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - economics; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Recurrence; Retrospective Studies; Stents - economics; Thrombolytic Therapy - economics; Thrombolytic Therapy - mortality; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/(SICI)1522-726X(200002)49:2<135::AID-CCD4>3.0.CO;2-B

We investigated the clinical effectiveness and relative cost of two different infarct artery revascularization strategies in patients following systemic thrombolysis for acute myocardial infarction. The clinical efficacy and relative cost of stenting and angioplasty have not been investigated in patients requiring infarct artery revascularization after systemic thrombolysis for myocardial infarction. We prospectively enrolled 220 consecutive patients who received thrombolytic therapy for acute myocardial infarction and were subsequently treated with either angioplasty or primary stenting of the infarct artery. In‐hospital and 1‐year clinical outcomes, including death, myocardial infarction, and repeat revascularization, and total hospital costs over the 1‐year study period were assessed. Compared to angioplasty, primary stenting resulted in lower in‐hospital mortality (4% vs. 0%; P = 0.01) and reduced rates of repeat percutaneous or surgical revascularization (7% vs. 0%; P = 0.0009). At 1‐year follow‐up, stenting was associated with a lower death rate (6.25% vs. 0%; P = 0.002) and reduced repeat infarct artery revascularization (11% vs. 27%; P = 0.001). Initial hospitalization costs were higher in the stent group ($11,818 ± $3,377 vs. $9,723 ± $8,661; P = 0.014) due primarily to catheterization laboratory‐related expenditures ($7,346 ± $2,395 vs. $3,567 ± $1,212; P = 0.0001). However, the cumulative 1‐year medical cost difference between the two groups was not significant ($13,938 ± $5,939 vs. $12,914 ± $9,308; P = 0.33). Following thrombolytic therapy, primary infarct artery stenting reduced in‐hospital and 1‐year mortality and revascularization rates compared to angioplasty. Stenting was associated with higher initial hospital costs, which were off‐set by lower revascularization rates, resulting in comparable total hospitalization costs after 1 year. These findings have important clinical and economic implications in an increasingly cost‐conscious health care environment. Cathet. Cardiovasc. Intervent. 49:135–141, 2000. © 2000 Wiley‐Liss, Inc.