Machecourt Jacques, Bonnefoy Eric, Vanzetto Gérald, Motreff Pascal, Marlière Stéphanie, Leizorovicz Alain, Allenet Benoit, Lacroute Jean Michel, Cassagnes Jean, Touboul Paul
Coronary Care Unit, CHU Grenoble, Grenoble, France.
J Am Coll Cardiol. 2005 Feb 15;45(4):515-24. doi: 10.1016/j.jacc.2004.11.031.
This ancillary study of the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) trial sought to assess the cost-efficacy ratio of primary coronary angioplasty (PCA) and pre-hospital thrombolysis (PHT) in patients suffering from an acute myocardial infarction (AMI) (<6 h) close to (<60 min journey) a percutaneous coronary intervention (PCI) center.
In the CAPTIM study, at 30 days follow-up PCA was as equally effective as PHT with rescue angioplasty if needed. The cost efficacy of these two strategies has not yet been compared.
Data were prospectively collected for 299 patients in three centers. The efficacy analysis was extended at one-year follow-up for those patients. Direct fixed and variable actual costs were assessed with a piggyback data collection.
The one-year primary end point event-rate (death, non-fatal myocardial infarction, and stroke) was not different after PCA or PHT (14% vs. 16. 4%, p = NS). Costs were lower in the PCA group either during the in-hospital period (8,287 vs. 9,170 $, p = 0.0001) and after one-year follow-up, in relation to a higher rate of subsequent revascularizations in the PHT group (49% vs. 23%, p < 0. 01), leading to a longer hospital stay (10 vs. 9.1 days, p = 0. 03).
After AMI in patients less than 1 h from a PCI center, PCA is as effective and less costly than a combined strategy of PHT followed by rescue angioplasty.
本急性心肌梗死血管成形术与院前溶栓比较（CAPTIM）试验的辅助研究旨在评估在距离经皮冠状动脉介入治疗（PCI）中心较近（行程<60分钟）且患有急性心肌梗死（AMI，<6小时）的患者中，直接冠状动脉成形术（PCA）和院前溶栓（PHT）的成本效益比。
在CAPTIM研究中，30天随访时，PCA与必要时行补救血管成形术的PHT效果相当。这两种策略的成本效益尚未进行比较。
前瞻性收集了三个中心299例患者的数据。对这些患者进行了为期一年的随访疗效分析。通过附带的数据收集评估直接固定成本和可变实际成本。
PCA或PHT治疗后一年的主要终点事件发生率（死亡、非致命性心肌梗死和中风）无差异（14%对16.4%，p=无显著性差异）。PCA组在住院期间（8287美元对9170美元，p=0.0001）以及一年随访后的成本较低，这与PHT组较高的后续血运重建率有关（49%对23%，p<0.01），导致住院时间更长（10天对9.1天，p=0.03）。
对于距离PCI中心不到1小时路程的AMI患者，PCA与PHT后行补救血管成形术的联合策略效果相同，但成本更低。
