Key result
Primary infarct artery stenting following systemic thrombolysis for acute myocardial infarction reduced 1-year mortality (0% vs. 6.25%; P=0.002) compared to angioplasty.
Why the study?
Does primary stenting improve clinical outcomes and reduce costs compared to angioplasty in patients requiring infarct artery revascularization after systemic thrombolysis for acute myocardial infarction?
Cohort (n=220)
Does primary stenting improve clinical outcomes and reduce costs compared to angioplasty in patients requiring infarct artery revascularization after systemic thrombolysis for acute myocardial infarction?
Absolute Event Rate: 0% vs 6.25%
p-value: p=0.002
Primary stenting of the infarct artery following systemic thrombolysis for acute myocardial infarction reduces 1-year mortality and repeat revascularization compared to angioplasty, with comparable total 1-year hospitalization costs.
Stenting was associated with lower mortality after thrombolysis; hypothesis-generating and requires randomized confirmation.
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.
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Rocha‐Singh et al. (2000) conducted a cohort in Acute myocardial infarction following systemic thrombolysis (n=220). Primary infarct artery stenting vs. Angioplasty was evaluated on 1-year death rate (p=0.002). Primary infarct artery stenting following systemic thrombolysis for acute myocardial infarction reduced 1-year mortality (0% vs. 6.25%; P=0.002) compared to angioplasty.