Impact of abciximab and coronary stenting on outcomes and costs of percutaneous coronary interventions in a community hospital

Objective To assess costs and outcomes of coronary stenting and balloon ang ioplasty with and without adjunctive treatment with abciximab for 3758 cons ecutive elective percutaneous coronary interventions at a single community center over the 2.5-year period between 1 January 1995 and 30 June 1997. Results Abciximab was more common among patients who had recently suffered myocardial infarction, patients with unstable angina, and patients with mor e complex coronary lesions, Use of abciximab in conjunction with balloon an gioplasty or stenting and stenting alone was associated with significant re ductions in incidence of major adverse cardiovascular events in hospital. M ultivariate analysis indicated that use of abciximab and stenting were asso ciated with significant independent effects on risk of an event. Hospital c osts were increased for patients administered abciximab, treated with stent ing, or both, Total costs and costs inclusive of those incurred in catheter ization laboratory and pharmacy increased significantly with increasing com plexity of lesions. Multivariate regression analysis (baseline cost US$5621 ) identified death (US$16 098), emergency revascularization (US$13 678), us age of multiple stents (US$1423 for each stent), and use of abciximab (US$1 269) as independent predictors of a greater cost. One-year follow-up reveal ed significant differences among treatment strategies in terms of risk of n eed for subsequent revascularization procedures. Lack of stenting but not u se of abciximab was identified as a significant predictor of need for repea t revascularization procedures. Conclusions Our findings are in general agreement with cost analyses of use of abciximab for populations in clinical trials and suggest that improveme nts of early clinical outcome with abciximab treatment and stenting justify the incremental cost of treatment in a community hospital setting. Coron A rtery Dis 12:135-142 (C) 2001 Lippincott Williams & Wilkins.