This Article Full Text Full Text (PDF) All Versions of this Article: 108/21/2624    most recent 01.CIR.0000097120.26062.FEv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Le May, M. R. Articles by Higginson, L. A. Search for Related Content PubMed PubMed Citation Articles by Le May, M. R. Articles by Higginson, L. A. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Heart Attack Related Collections Fibrinolysis Catheter-based coronary interventions: stents Acute myocardial infarction

(Circulation. 2003;108:2624.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Hospitalization Costs of Primary Stenting Versus Thrombolysis in Acute Myocardial Infarction

Cost Analysis of the Canadian STAT Study

Michel R. Le May, MD; Richard F. Davies, MD, PhD; Marino Labinaz, MD; Heather Sherrard, BScN, MHA; Jean-François Marquis, MD; Louise A. Laramée, MD; Edward R. O’Brien, MD; William L. Williams, MD; Rob S. Beanlands, MD; Graham Nichol, MD; Lyall A. Higginson, MD

From the Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.

Correspondence to Michel R. Le May, MD, Ottawa Heart Institute, 40 Ruskin St, Ottawa, Ontario, Canada K1Y 4W7. E-mail mlemay{at}ottawaheart.ca

Received November 14, 2002; de novo received June 30, 2003; revision received August 22, 2003; accepted August 26, 2003.

Background— We previously showed that primary stenting was more effective than accelerated tPA in reducing the 6-month composite of death, reinfarction, stroke, or repeat revascularization for ischemia. This study looks at the hospitalization costs of primary stenting compared with accelerated tPA.

Methods and Results— Initial and 6-month hospitalization costs were computed for all patients randomly assigned to primary stenting (n=62) or accelerated tPA (n=61) in the Stenting versus Thrombolysis in Acute myocardial infarction Trial (STAT). Costs and resource usage were collected in detail for each patient. Physician fees were obtained directly from billings to the Ontario Health Insurance Plan. The length of initial hospitalization was 6.7±11.3 days in the stent group and 8.7±6.7 days in the tPA group (P<0.001). Total hospitalization days at 6 months were 8.3±13 days in the stent group and 12.1±14.0 days in the tPA group (P=0.001). Hospitalization costs were less in the stent group for the initial hospitalization, $6354±6382 versus $7893±4429 (P=0.001), and at 6 months, $7100±7111 versus $9559±6933 (P=0.001).

Conclusions— In centers in which facilities and experienced interventionists are available, primary stenting is less costly and more effective than thrombolysis.

Key Words: myocardial infarction • stents • thrombolysis • cost-benefit analysis

This article has been cited by other articles:

				M. R. Le May, D. Y. So, R. Dionne, C. A. Glover, M. P.V. Froeschl, G. A. Wells, R. F. Davies, H. L. Sherrard, J. Maloney, J.-F. Marquis, et al. A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction N. Engl. J. Med., January 17, 2008; 358(3): 231 - 240. [Abstract] [Full Text] [PDF]

				B. K. Nallamothu, H. M. Krumholz, D. T. Ko, K. A. LaBresh, S. Rathore, M. T. Roe, and L. Schwamm Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: Gaps, Barriers, and Implications Circulation, July 10, 2007; 116(2): e68 - e72. [Full Text] [PDF]

				N Melikian, K Morgan, and K J Beatt Can the published cost analysis data for delivery of an efficient primary angioplasty service be applied to the modern National Health Service? Heart, October 1, 2005; 91(10): 1262 - 1264. [Abstract] [Full Text] [PDF]

				M. Ivanusa Reducing mortality in myocardial infarction: Goal should be interhospital transfer for primary angioplasty BMJ, May 28, 2005; 330(7502): 1271 - 1271. [Full Text]

				J. Machecourt, E. Bonnefoy, G. Vanzetto, P. Motreff, S. Marliere, A. Leizorovicz, B. Allenet, J. M. Lacroute, J. Cassagnes, and P. Touboul Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a percutaneous coronary intervention center: The Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) cost-efficacy sub-study J. Am. Coll. Cardiol., February 15, 2005; 45(4): 515 - 524. [Abstract] [Full Text] [PDF]

				PCI Plus Stenting Cheaper Than Thrombolysis in Canada Journal Watch Emergency Medicine, January 21, 2004; 2004(121): 2 - 2. [Full Text]