Key result
Primary angioplasty significantly reduced major adverse cardiac events at one year compared to thrombolysis (13.2% vs 57.4%; AOR 8.6; p<0.001) and was cost-neutral.
Why the study?
Does primary angioplasty improve clinical outcomes and cost-effectiveness compared to thrombolysis in patients with STEMI?
Cohort (n=400)
Yes
Does primary angioplasty improve clinical outcomes and cost-effectiveness compared to thrombolysis in patients with STEMI?
Odds Ratio: 8.6
Absolute Event Rate: 13.2% vs 57.4%
p-value: p=<0.001
Primary angioplasty for STEMI provides substantial clinical benefits over thrombolysis while remaining cost-neutral in a real-world setting.
Supports primary angioplasty in real-world STEMI; extends observational data but leaves open need for randomized confirmation.
AIMS: The aim of this study is to use real-world data from West London to compare the cost-effectiveness of a contemporary primary angioplasty (PPCI) service to thrombolysis which it superseded over a time horizon of one year. Previous studies have depended on randomised trials and economic modelling. METHODS AND RESULTS: Resource and outcome data were collected on 400 consecutive patients treated for ST segment elevation myocardial infarction (STEMI) at the hub and two spoke sites over three years. After the first 200 received thrombolysis, the PPCI service was introduced providing treatment for the next 200 cases. The incidence of major adverse cardiac events was significantly less in the PPCI group at 30 days (46.2% versus 7.0%, adjusted odds ratio (AOR) 12 p<0.001) and one year (57.4% versus 13.2%, AOR 8.6 p<0.001) driven by reductions in mortality and ischaemia driven revascularisations. Mean index and one year cumulative costs did not differ significantly between thrombolysis and PPCI (£7,016 versus £6,802; p=0.653 and £8442 versus £7,731; p=0.213 respectively). Initial angioplasty costs were significantly higher in the PPCI group offset by reduced hospital stay (8.5 versus 4 days; p<0.001). CONCLUSIONS: This model of PPCI delivery is associated with larger than expected benefits and is cost-neutral when compared to thrombolysis.
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Morgan et al. (2010) conducted a cohort in ST segment elevation myocardial infarction (STEMI) (n=400). Primary angioplasty (PPCI) vs. Thrombolysis was evaluated on Major adverse cardiac events at one year (AOR 8.6, p=<0.001). Primary angioplasty significantly reduced major adverse cardiac events at one year compared to thrombolysis (13.2% vs 57.4%; AOR 8.6; p<0.001) and was cost-neutral.
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