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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

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

Jacques Machecourt, MD^*,*, Eric Bonnefoy, MD, Gérald Vanzetto, MD^*, Pascal Motreff, MD, Stéphanie Marlière, MD^*, Alain Leizorovicz, MD, PhD, Benoit Allenet, PhD^||, Jean Michel Lacroute, MD^¶, Jean Cassagnes, MD and Paul Touboul, MD

^* Coronary Care Unit
^|| Pharmacy Department, CHU Grenoble, Grenoble, France
Coronary Care Unit, Hopital Louis Pradel, Lyon, France
Coronary Care Unit, Centre Hospitalo Universitaire Clermont Ferrand, Clermont Ferrand, France
Clinical Pharmacology Unit, Laennec University, Lyon, France
^¶ Service d'Aide Médicale Urgente (SAMU) 38, Grenoble, France

Manuscript received May 10, 2004; revised manuscript received October 30, 2004, accepted November 2, 2004.

^* Reprint requests and correspondence: Dr. Jacques Machecourt, Service Cardiologie et Urgences Cardiologiques, Centre Hospitalo Universitaire Grenoble BP 217 X 38043, Grenoble, France (Email: JMachecourt{at}chu-grenoble.fr).

OBJECTIVES: This ancillary study of the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) trial sought to assess the cost-efficacy ratio of primary coronary angioplasty (PCA) and pre-hospital thrombolysis (PHT) in patients suffering from an acute myocardial infarction (AMI) (<6 h) close to (<60 min journey) a percutaneous coronary intervention (PCI) center.

BACKGROUND: In the CAPTIM study, at 30 days follow-up PCA was as equally effective as PHT with rescue angioplasty if needed. The cost efficacy of these two strategies has not yet been compared.

METHODS: Data were prospectively collected for 299 patients in three centers. The efficacy analysis was extended at one-year follow-up for those patients. Direct fixed and variable actual costs were assessed with a piggyback data collection.

RESULTS: The one-year primary end point event-rate (death, non-fatal myocardial infarction, and stroke) was not different after PCA or PHT (14% vs. 16. 4%, p = NS). Costs were lower in the PCA group either during the in-hospital period (8,287 vs. 9,170 $, p = 0.0001) and after one-year follow-up, in relation to a higher rate of subsequent revascularizations in the PHT group (49% vs. 23%, p < 0. 01), leading to a longer hospital stay (10 vs. 9.1 days, p = 0. 03).

CONCLUSIONS: After AMI in patients less than 1 h from a PCI center, PCA is as effective and less costly than a combined strategy of PHT followed by rescue angioplasty.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAPTIM = Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction   PCA = primary coronary angioplasty   PCI = percutaneous coronary intervention   PHT = pre-hospital thrombolysis   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction

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