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J Am Coll Cardiol, 2005; 45:515-524, doi:10.1016/j.jacc.2004.11.031
© 2005 by the American College of Cardiology Foundation
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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{dagger}, Gérald Vanzetto, MD*, Pascal Motreff, MD{ddagger}, Stéphanie Marlière, MD*, Alain Leizorovicz, MD, PhD§, Benoit Allenet, PhD||, Jean Michel Lacroute, MD, Jean Cassagnes, MD{ddagger} and Paul Touboul, MD{dagger}

* Coronary Care Unit
|| Pharmacy Department, CHU Grenoble, Grenoble, France
{dagger} Coronary Care Unit, Hopital Louis Pradel, Lyon, France
{ddagger} 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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