Economic implications of coronary stenting with adjunctive IIb/IIIa receptor antagonists in a community hospital

To assess the implications of coronary stenting with several IIb/IIIa recep tor antagonists, total hospital cost and adverse events were reviewed for 6 74 elective stent procedures from June 1998 through December 1998. The use of IIb/IIIa receptor antagonism and the agent selected were at the discreti on of the interventional cardiologist. In-hospital, 30-day and 6-month adve rse cardiac events were similar among the treatment strategies. Target vess el revascularization at sis months was similar among the treatment strategi es. Patients who received a IIb/IIIa receptor blocker with their stent proc edure were less Likely to be rehospitalized within 30 days. Multivariate re gression analysis identified specific factors responsible for prolongation of hospital stay including adverse cardiac events, physician practice patte rn and age greater than 70 years (all p < 0.002). Overall hospital cost for patients receiving tirofiban as an adjunct to coronary stenting was approx imately $1,000 less than patients receiving abeiximab. Total cath lab expen ditures were similar for these groups and the savings in hospital cost was directly attributable to a lower pharmacy cost in the tirofiban group. Mult ivariate regression analysis identified adverse cardiac events, left ventri cular systolic dysfunction, multiple stent placement, physician practice an d abciximab as significant contributors to increased hospital cost (all p < 0.002). Tirofiban as an adjunct to coronary stenting was not identified by multivariate analysis as a significant contributor to hospital cost. Bleed ing rates were similar among the treatment strategies. Thus, coronary stent ing in our community hospital is associated with acceptable outcomes regard less of treatment strategy and hospital cost is significantly influenced by the use of IIb/IIIa blockade with stenting and the type of agent selected.