比伐卢定对 ST 段抬高型心肌梗死治疗的成本和结局的影响。

The effect of bivalirudin on costs and outcomes of treatment of ST-segment elevation myocardial infarction.

机构信息

School of Business and Law School, Stanford University, Stanford, CA 94305, USA.

出版信息

Am Heart J. 2011 Sep;162(3):494-500.e2. doi: 10.1016/j.ahj.2011.05.019. Epub 2011 Jul 26.

DOI:10.1016/j.ahj.2011.05.019

PMID:21884866

Abstract

BACKGROUND

Bivalirudin is commonly used during percutaneous coronary intervention (PCI) rather than unfractionated heparin. The higher cost of bivalirudin may be offset if it reduces costly bleeding complications and/or length of stay. We sought to assess the effect of using bivalirudin on the costs of care among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI.

METHODS

We analyzed data from 64,872 patients treated in 1 of 278 hospitals. The effect of overall hospital use of bivalirudin on clinical and economic outcomes was assessed using multivariable regression, based on average hospital use of treatments.

RESULTS

The use of bivalirudin among patients with STEMI treated with PCI varied widely across hospitals, with a median of 6.9% (interquartile range 2.3%-18.6%). After controlling for patient and hospital characteristics, use of bivalirudin rather than heparin and a glycoprotein IIb/IIIa inhibitor reduced bleeding (odds ratio 0.47, P < .001), length of stay (-0.47 days, P < .03), and hospital costs (-14%, P < .04).

CONCLUSIONS

Use of bivalirudin among patients with STEMI treated with PCI appears to reduce bleeding and overall costs.

摘要

背景

比伐卢定在经皮冠状动脉介入治疗（PCI）中比普通肝素更为常用。如果比伐卢定能够减少昂贵的出血并发症和/或住院时间，那么其较高的成本可能会得到弥补。我们旨在评估在接受 PCI 的 ST 段抬高型心肌梗死（STEMI）患者中使用比伐卢定对治疗费用的影响。

方法

我们分析了来自 278 家医院中 64872 名患者的数据。基于治疗的平均医院使用情况，使用多变量回归评估了整体医院使用比伐卢定对临床和经济结果的影响。

结果

接受 PCI 治疗的 STEMI 患者中比伐卢定的使用在医院间差异很大，中位数为 6.9%（四分位距 2.3%-18.6%）。在控制了患者和医院特征后，与使用肝素和糖蛋白 IIb/IIIa 抑制剂相比，使用比伐卢定可减少出血（比值比 0.47，P<.001）、住院时间（-0.47 天，P<.03）和医院费用（-14%，P<.04）。