Abstract 317: Costs and Benefits Associated with Transradial Percutaneous Coronary Intervention in China

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Chen Jin ◽  
Xin-ran Tang ◽  
Qiu-ting Dong ◽  
Wei Li ◽  
Wei Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Length Of Stay ◽  
Cost Saving ◽  
Coronary Intervention ◽  
Observational Research ◽  
Bleeding Complications ◽  
Costs And Benefits ◽  
Hospital Outcomes ◽  
Percutaneous Coronary

Background: Transradial percutaneous coronary intervention (TRI) has been increasingly used in the treatment of ischemic heart disease. While there are few studies examining the costs and benefits of transradial vs. transfemoral (TFI) in experienced centers among highly selected patients, treatment patterns and cost data obtained from the United States and European countries might not be generalizable to the developing world. Methods: We performed a retrospective analysis of patients undergoing PCI in the largest heart center in China between January and December 2010. Propensity score inverse probability weighting (IPW) method was used to compare costs and in-hospital outcomes between TRI and TFI, while controlling for potential treatment selection inherent in observational research. Results: Of 5,307patients undergoing PCI, 4,684 (88.3%) received TRI. Those undergoing TRI were younger, were less likely to be female, less likely to have prior myocardial infarction, PCI, or CABG, and more often presented with STEMI. After IPW adjustment, TRI was associated with fewer bleeding complications (BARC≥3 0.7% vs. 2.2%, OR 0.36, 95% CI 0.18-0.68), major adverse cardiovascular event (a composite of death, myocardial infarction, BARC bleeding≥3 or unplanned revascularization; 1.8% vs. 4.0%, OR 0.49, 95% CI 0.31-0.79), and shorter length of stay (6.1 vs 8.3 days, adjusted difference -1.5 days, 95% CI -1.9 to -1.2; Table ). TRI was associated with a cost saving of $1,261 (95% CI $967-$1,557) as compared with TFI. The cost saving was mainly driven by reduced procedural-related cost ($761) from differential use of vascular closure device and lower hospitalization cost ($217) related to shorter length of stay. Similar results were found in clinically relevant groups of myocardial infarction (STEMI and NSTEMI), acute coronary syndrome (STEMI, NSTEMI, and unstable angina), and stable angina. Conclusions: Compared with the TFI approach, TRI was associated with fewer complications, shorter length of stay, lower costs, and improved in-hospital outcomes.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

Percutaneous Coronary Intervention–Related Bleeding Risk Factors in Current Practice

2005 ◽  
Vol 39 (10) ◽  
pp. 1627-1633 ◽  
Author(s):  
A Scott Mathis ◽  
James J Gugger
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Renal Function ◽  
Length Of Stay ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Minor Bleeding ◽  
Prolonged Length ◽  
Percutaneous Coronary

BACKGROUND: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Little is known about the risk factors for bleeding complications. Objective: To report our PCI-related observations from a single institution and use the information to establish risk factors for short-term bleeding complications, with special focus on examining the importance of renal function. METHODS: A retrospective record review was conducted of the admission of 300 patients grouped according to antithrombotic regimen: unfractionated heparin alone (n = 187), bivalirudin (n = 26), and glycoprotein IIb/IIIa antagonist plus heparin (n = 103). Bleeding and ischemic outcomes were tracked. A model was constructed to predict independent bleeding risk factors. RESULTS: Treatment groups differed significantly regarding any bleeding (p = 0.001), minor bleeding (p < 0.001), and length of stay (p = 0.01). Multivariate predictors of any bleeding included antithrombotic regimen, creatinine clearance (Clcr) <30 mL/min, and hypertension. Any bleeding was associated with prolonged length of stay. Major bleeding was predicted by Clcr <30 mL/min and was associated with prolonged length of stay and death. Minor bleeding was predicted only by choice of antithrombotic regimen. CONCLUSIONS: The major influences on bleeding risk appeared to be Clcr <30 mL/min and choice of antithrombotic regimen. It is important to note that other markers of renal function, including serum creatinine value and serum creatinine at a cutoff level of 1.5 mg/dL, did not predict bleeding events.

Sign in / Sign up

Export Citation Format

Share Document