title: Clinical outcomes and cost implications of routine early PCI after fibrinolysis: one-year follow-up of the Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) study.
abstract: BACKGROUND
  In patients with ST-elevation myocardial infarction treated with fibrinolysis, routine early percutaneous coronary intervention (r-PCI) improves clinical outcomes at 30 days compared with a more standard approach of performing early PCI only for failed fibrinolysis (s-PCI).
  
  
  METHODS
  We report prespecified secondary clinical outcomes and cost implications of r-PCI compared with s-PCI from the Canadian TRANSFER-AMI trial. Average cost per patient in each arm was calculated based on a microcosting approach. Bootstrap method (5,000 samples) was used to calculate standard errors and 95% CI.
  
  
  RESULTS
  At 1 year, rates of death or reinfarction (10.3% vs 11.6%, P = .50), hospital readmission (15.4% vs 16.5%, P = .64) and subsequent revascularization after index hospitalization (6.9% vs 8.7%, P = .30) were similar between the r-PCI and s-PCI arms. The difference in cost per patient between r-PCI and s-PCI was CAD $1,003 (95% CI, -$247 to $2,211). Since a greater proportion of patients were transported by air (vs land) in the r-PCI arm (9.4% vs 3%), and the ratio of abciximab to eptifibatide use was higher in the r-PCI arm compared with s-PCI (2:1 vs 4:5), we undertook additional post hoc cost scenario analyses. In a scenario where patients are transported by land only and eptifibatide is used as the sole GPIIb/IIIa inhibitor, the difference in cost per patient between r-PCI and s-PCI was estimated to be CAD $108 (95% CI, -$1,114 to $1,344).
  
  
  CONCLUSIONS
  At 1 year, there is no difference in the clinical composite outcome of death or reinfarction between r-PCI and s-PCI strategies. Greater cost with r-PCI, although statistically insignificant, is economically important.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bagai
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Mary
authors.initials: M
authors.lastname: Tan
authors.forename: Wesley
authors.initials: W
authors.lastname: Tong
authors.forename: Andre
authors.initials: A
authors.lastname: Lamy
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Eric A
authors.initials: EA
authors.lastname: Cohen
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.forename: John
authors.initials: J
authors.lastname: Ducas
authors.forename: Michael
authors.initials: M
authors.lastname: Heffernan
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.forename: Laurie
authors.initials: L
authors.lastname: Morrison
authors.forename: Brian
authors.initials: B
authors.lastname: Schwartz
authors.forename: Charles
authors.initials: C
authors.lastname: Lazzam
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics; D002170:Canada; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000191:economics / Q000379:methods*; D015607:Stents; D015912:Thrombolytic Therapy; D016896:Treatment Outcome