Cost implications of intraprocedural thrombotic events during PCI.
OBJECTIVE
We sought to estimate the direct costs (in-hospital and 30-day) associated with an intraprocedural thrombotic event (IPTE) among patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) undergoing percutaneous coronary intervention (PCI).


BACKGROUND
Patients with IPTE have higher rates of in-hospital and 30-day major adverse cardiac events than patients without IPTE. The extent to which IPTE also add to medical costs is unknown.


METHODS
Hospital costs for patients in the ACUITY Trial were compared between patients with and without IPTE. Adjusted comparisons were performed using generalized linear models (GLMs). All costs are reported in 2012 US dollars.


RESULTS
A total of 1,307 patients with both core laboratory-based angiographic assessment and detailed economic data were included in the final study population. IPTE occurred in 52 patients (4.0%). Median in-hospital costs were higher in patients with IPTE than in those without IPTE ($23,719 vs. $18,419, P = 0.01). Thirty-day median costs were also higher for IPTE patients ($23,719 vs. $19,556, P = 0.05). After adjusting for baseline differences, IPTE was associated with 19.5% (95% CI: [2.8-38.8%], P = 0.02) and 18.9% (95% CI: [1.2-39.7%], P = 0.04) increases in in-hospital and 30-day costs, respectively. These relative differences represent median increases of $3,592 in initial hospital costs and $3,696 in 30-day costs.


CONCLUSIONS
The occurrence of IPTE during the index PCI in patients with NSTEACS is associated with substantial increases in-hospital and 30-day costs. These findings suggest that strategies to prevent IPTE may be associated with important cost offsets as well as improved clinical outcomes.
The Medicines Company, Parsippany, New Jersey.
Stephanie
S
Plent
The Medicines Company, Parsippany, New Jersey.
Weihong
W
Fan
Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
Ajay
A
Kirtane
New York Methodist Hospital, Brooklyn, NY and the Cardiovascular Research Foundation, New York, New York.
Sorin J
SJ
Brener
Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
Philippe
P
Genereux
Mt Sinai Medical Center and the Cardiovascular Research Foundation, New York, New York.
Roxana
R
Mehran
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Duane S
DS
Pinto
Department of Medicine, Golden Jubilee National Hospital, Glasgow, Scotland.
Margaret
M
McEntegart
Saint-Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
David J
DJ
Cohen
Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York.
Gregg W
GW
Stone
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011859:Radiography; D013927:Thrombosis / Q000191:economics* / Q000209:etiology; D016896:Treatment Outcome
coronary artery disease; economics/cost-effectiveness; percutaneous coronary intervention