Author + information
- Received December 22, 1994
- Revision received April 20, 1995
- Accepted April 27, 1995
- Published online September 1, 1995.
- Daniel B. Mark, MD, MPH, FACCa,*,
- William W. O'Neill, MD, FACC*,
- Bruce Brodie, MD, FACC†,
- Russell Ivanhoe, MD, FACC‡,
- William Knopf, MD, FACC§,
- George Taylor, MD, FACC‖,
- James H. O'Keefe, MD, FACC¶,
- Cindy L. Grines, MD, FACC*,
- Linda Davidson-Ray, BAa,
- J. David Knight, MSa and
- Robert M. Califf, MD, FACCa
- ↵*Address for correspondence: Dr. Daniel B. Mark. P.O. Box 3485, Duke University Medical Center, Durham, North Carolina 27710.
Objectives This study sought to describe the economic outcomes from a prospective multicenter registry of primary coronary angioplasty.
Background Interest in coronary angioplasty without preceding thrombolytic therapy as a primary reperfusion strategy has increased as a result of three recent randomized trials showing outcomes equivalent to or better than standard thrombolytic therapy.
Methods The Primary Angioplasty Registry enrolled 270 patients with acute myocardial infarction at six private tertiary care medical centers. Baseline and follow-up medical costs and counts of resources consumed were collected from enrollment to the 6-month follow-up visit. Correlates and predictors of cost were identified with multivariable linear regression modeling.
Results Ninety-five percent of patients had a revascularization procedure during the baseline hospital period: 85% had coronary angioplasty only; 4% had coronary bypass surgery only; 6% had both procedures. The total mean baseline hospital cost (not charge) was $13,113, with mean physician fees of $5,694. During the follow-up period, repeat coronary angiography was performed in 21% of patients, whereas 13% had repeat angioplasty and 3% bypass surgery. Mean hospital follow-up costs were $3,174, with mean physician fees of $1,443. Independent correlates of higher 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 addition to angioplasty (p < 0.0001) and recurrent ischemia (p < 0.0001).
Conclusions Costs of primary angioplasty for patients with acute myocardial infarction eligible for thrombolysis were strongly influenced by infarction- and procedure-related complications but only modestly influenced by patient selection factors.
This study was supported in part by a grant from Advanced Cardiovascular Systems, Mountainview, California: Research Grants HL-36587 and HL-17670 from the National Heart, Lung. and Blood Institute, National Institutes of Health. Bethesda, Maryland; Research Grants HS-05636 and HS-06503 from the Agency for Health Care Policy and Research, Rockville, Maryland: and a grant from the Robert Wood Johnson Foundation, Princeton. New Jersey.
- Received December 22, 1994.
- Revision received April 20, 1995.
- Accepted April 27, 1995.
- American College of Cardiology