Key result
Early invasive strategy after thrombolysis resulted in similar quality-adjusted life years (mean difference 0.008; 95% CI -0.027 to 0.043) and costs compared to a late invasive strategy.
Why the study?
Does an early invasive strategy improve 12-month quality-adjusted life years and costs compared to a late invasive strategy in STEMI patients receiving thrombolysis?
RCT (n=266)
randomized
Yes
Does an early invasive strategy improve 12-month quality-adjusted life years and costs compared to a late invasive strategy in STEMI patients receiving thrombolysis?
In STEMI patients treated with thrombolysis due to expected PCI delays, an early invasive strategy results in similar quality of life and costs at 12 months compared to a late invasive strategy.
Supports individualized invasive timing after thrombolysis in STEMI; confirms equivalent 12-month QALYs and costs.
UNLABELLED: The NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction showed an improved clinical outcome with early transfer for percutaneous coronary intervention (PCI) compared to a more conservative approach after thrombolysis. The aim of this substudy was to compare the 12-month quality-adjusted life years (QALYs) and costs of these alternative strategies. METHODS: Patients with ST-elevation myocardial infarction <6 h duration and >90 min expected delay to PCI, received full-dose tenecteplase and were randomized to either early or late invasive strategy (n = 266). Detailed quality of life and resource use data were registered prospectively for a period of 12 months. Health outcomes were measured as quality of life using a generic instrument (15D). Quality of life scores were translated into QALYs. Unit costs were based on hospital accounts, fee schedules, and market prices. RESULTS: After 12 months of follow-up, patients in the early invasive group had 0.008 (95% CI -0.027 to 0.043) more QALYs compared to the late invasive group. The mean total costs were €18,201 in the early versus €17,643 in the late invasive group, with a mean difference of €558 (95% CI -2258 to 3484). Cost/QALY was €69,750 while cost/avoided clinical endpoint was €5636. CONCLUSION: Early and late invasive strategies after thrombolysis resulted in similar quality of life and similar costs in ST-elevation myocardial infarction patients living far from a PCI centre (NCT00161005).
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Bøhmer et al. (2011) conducted an RCT in ST-elevation myocardial infarction (n=266). Early invasive strategy vs. Late invasive strategy was evaluated on 12-month quality-adjusted life years (QALYs) (MD 0.008, 95% CI -0.027 to 0.043). Early invasive strategy after thrombolysis resulted in similar quality-adjusted life years (mean difference 0.008; 95% CI -0.027 to 0.043) and costs compared to a late invasive strategy.
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