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. 2001 Jun;85(6):667–671. doi: 10.1136/heart.85.6.667

Long term outcome and cost-effectiveness of stenting versus balloon angioplasty for acute myocardial infarction

H Suryapranata 1, J Ottervanger 1, E Nibbering 1, H van't 1, J Hoorntje 1, M J de Boer 1, M Al 1, F Zijlstra 1
PMCID: PMC1729781  PMID: 11359749

Abstract

OBJECTIVE—To investigate the long term clinical outcome and cost-effectiveness of stenting compared with balloon angioplasty in patients with acute myocardial infarction.
METHODS—Patients with acute myocardial infarction were randomly allocated to primary stenting (112) or balloon angioplasty (115). The primary end point was the cumulative first event rate of death, non-fatal reinfarction, or target vessel revascularisation. Secondary end points were restenosis at six months and the cost-effectiveness at follow up.
RESULTS—After 24 months, the combined clinical end point of death/reinfarction was 4% after stenting and 11% after balloon angioplasty (p = 0.04). Subsequent target vessel revascularisation was necessary in 15 patients (13%) after stenting and in 39 (34%) after balloon angioplasty (p < 0.001). The cumulative cardiac event-free survival rate was also higher after stenting (84% v 62%, p < 0.001). The angiographic restenosis rate after stenting was less than after balloon angioplasty (12% v 34%, p < 0.001). Despite the higher initial costs of stenting (Dfl 21 484 v Dfl 18 625, p < 0.001), the cumulative costs at 24 months were comparable with those of balloon angioplasty (Dfl 31 423 v Dfl 32 933, p = 0.83).
CONCLUSIONS—Compared with balloon angioplasty, primary stenting for acute myocardial infarction results in a better long term clinical outcome without increased cost.


Keywords: stenting; angioplasty; myocardial infarction; cost-benefit analysis

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Figure 1  .

Figure 1  

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(A) Cumulative first event-free survival (no death, non-fatal reinfarction, or myocardial revascularisation during 24 months of follow up). (B) Cumulative costs per patient in Dutch guilders (Dfl) during follow up in both stent (solid line) and balloon (dotted line) groups.

Figure 2  .

Figure 2  

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A bivariate normal distribution of differences in costs and effects in a two dimensional plane, together with the uncertainties surrounding the estimates. A 95% confidence ellipse, a simultaneous confidence region for both costs and effects, is depicted. The probability that the inner ellipse includes the true incremental costs and effectiveness is 5%. For the middle ellipse, this is 50%, and for the outer ellipse, 95%.

Figure 3  .

Figure 3  

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Cumulative frequency of diameter stenosis (%) in both groups, as obtained from the independent core laboratory.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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