BASE-LINE AND 6-MONTH COSTS OF PRIMARY ANGIOPLASTY THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - RESULTS FROM THE PRIMARY ANGIOPLASTY REGISTRY

Objectives. This study sought to describe the economic outcomes from a prospective multicenter registry of primary coronary angioplasty. Bac kground. Interest in coronary angioplasty without preceding thrombolyt ic therapy as a primary reperfusion strategy has increased as a result of three recent randomized trials shelving outcomes equivalent to or better than standard thrombolytic therapy. Methods. The Primary Angiop lasty Registry enrolled 270 patients with acute myocardial infarction at six private tertiary care medical centers. Baseline and follow-up m edical costs and counts of resources consumed were collected from enro llment to the 6-month follow-up visit. Correlates and predictors of co st were identified with multivariable linear regression modeling. Resu lts. Ninety-five percent of patients had a revascularization procedure during the baseline hospital period: 85% had coronary angioplasty onl y; 4% had coronary bypass surgery only; 6% had bath procedures. The to tal mean baseline hospital cost (not charge) was $13,113, with mean ph ysician fees of $5,694. During the follow-up period, repeat coronary a ngiography was performed in 21% of patients, whereas 13% had repeat an gioplasty and 3% bypass surgery, Mean hospital follow-up costs were $3 ,174, with mean physician fees of $1,443, Independent correlates of hi gher baseline hospital costs included older age (p = 0.049), anterior infarction (p = 0.03), initial Killip class (p < 0.0001), more severe coronary disease (p = 0.0015), need for bypass surgery alone or in add ition to angioplasty (p < 0.0001) and recurrent ischemia (p < 0.0001). Conclusions. Costs of primary angioplasty for patients with acute myo cardial infarction eligible for thrombolysis were strongly influenced by infarction- and procedure-related complications but only modestly i nfluenced by patient selection factors.