Primary stenting for acute myocardial infarction resulted in a higher 24-month cardiac event-free survival rate compared to balloon angioplasty (84% vs 62%, P<0.001) without increased cumulative costs.
RCT (n=227)
randomly allocated
Does primary stenting improve long-term clinical outcomes and cost-effectiveness compared to balloon angioplasty in patients with acute myocardial infarction?
Primary stenting for acute myocardial infarction significantly improves long-term event-free survival and reduces target vessel revascularization compared to balloon angioplasty, without increasing cumulative costs at 24 months.
Absolute Event Rate: 84% vs 62%
p-value: p=<0.001
OBJECTIVE: To investigate the long term clinical outcome and cost-effectiveness of stenting compared with balloon angioplasty in patients with acute myocardial infarction. METHODS: Patients with acute myocardial infarction were randomly allocated to primary stenting (112) or balloon angioplasty (115). The primary end point was the cumulative first event rate of death, non-fatal reinfarction, or target vessel revascularisation. Secondary end points were restenosis at six months and the cost-effectiveness at follow up. RESULTS: After 24 months, the combined clinical end point of death/reinfarction was 4% after stenting and 11% after balloon angioplasty (p = 0.04). Subsequent target vessel revascularisation was necessary in 15 patients (13%) after stenting and in 39 (34%) after balloon angioplasty (p < 0.001). The cumulative cardiac event-free survival rate was also higher after stenting (84% v 62%, p < 0.001). The angiographic restenosis rate after stenting was less than after balloon angioplasty (12% v 34%, p < 0.001). Despite the higher initial costs of stenting (Dfl 21 484 v Dfl 18 625, p < 0.001), the cumulative costs at 24 months were comparable with those of balloon angioplasty (Dfl 31 423 v Dfl 32 933, p = 0.83). CONCLUSIONS: Compared with balloon angioplasty, primary stenting for acute myocardial infarction results in a better long term clinical outcome without increased cost.
Suryapranata et al. (Fri,) conducted a rct in acute myocardial infarction (n=227). Primary stenting vs. Balloon angioplasty was evaluated on Cumulative first event rate of death, non-fatal reinfarction, or target vessel revascularisation (reported as event-free survival) (p=<0.001). Primary stenting for acute myocardial infarction resulted in a higher 24-month cardiac event-free survival rate compared to balloon angioplasty (84% vs 62%, P<0.001) without increased cumulative costs.