Sloth Astrid D, Schmidt Michael R, Munk Kim, Schmidt Morten, Pedersen Lars, Sørensen Henrik T, Enemark Ulrika, Parner Erik T, Bøtker Hans Erik
Department of Cardiology, Aarhus University Hospital, Denmark
Department of Cardiology, Aarhus University Hospital, Denmark.
Eur Heart J Acute Cardiovasc Care. 2017 Apr 1;6(3):244–253. doi: 10.1177/2048872615626657. Epub 2016 Jan 26.
Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction from the perspective of the Danish healthcare system.
Between February 2007 and November 2008, 251 patients with ST-elevation myocardial infarction were randomly assigned to remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention (n=126) or to primary percutaneous coronary intervention alone (n=125). During a 4-year follow-up period, we used data from Danish medical registries and medical records to estimate within-trial cardiovascular medical care costs and major adverse cardiac and cerebrovascular event-free survival. After 4 years of follow-up, mean cumulative cardiovascular medical care costs were €2763 (95% confidence interval 207-5318, P=0.034) lower in the remote ischaemic conditioning group than in the control group (€12,065 vs. €14,828), while mean major adverse cardiac and cerebrovascular event-free survival time was 0.30 years (95% confidence interval 0.03-0.57, P=0.032) higher in the remote ischaemic conditioning group than in the control group (3.51 vs. 3.21 years). In the cost-effectiveness plane, remote ischaemic conditioning therapy was economically dominant (less costly and more effective) in 97.26% of 10,000 bootstrap replications.
Remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention appears to be a cost-effective treatment strategy in patients with ST-elevation myocardial infarction.
远程缺血预处理似乎可改善接受直接经皮冠状动脉介入治疗患者的长期临床结局。远程缺血预处理可通过血压袖带交替充气和放气的周期来实施。我们从丹麦医疗保健系统的角度评估了远程缺血预处理作为ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗辅助手段的成本效益。
2007年2月至2008年11月期间，251例ST段抬高型心肌梗死患者被随机分配接受远程缺血预处理作为直接经皮冠状动脉介入治疗的辅助手段（n = 126）或仅接受直接经皮冠状动脉介入治疗（n = 125）。在4年的随访期内，我们使用丹麦医疗登记处和病历数据来估算试验期间的心血管医疗费用以及无主要不良心脑血管事件的生存率。随访4年后，远程缺血预处理组的平均累积心血管医疗费用比对照组低2763欧元（95%置信区间207 - 5318，P = 0.034）（12,065欧元对14,828欧元），而远程缺血预处理组的平均无主要不良心脑血管事件生存时间比对照组高0.30年（95%置信区间0.03 - 0.57，P = 0.032）（3.51年对3.21年）。在成本效益平面中，在10,000次自抽样重复中，97.26%的情况下远程缺血预处理疗法在经济上占优势（成本更低且效果更佳）。
远程缺血预处理作为直接经皮冠状动脉介入治疗的辅助手段，似乎是ST段抬高型心肌梗死患者具有成本效益的治疗策略。
