Heart 2001;85:667-671 ( June )

Interventional cardiology surgery

Long term outcome and cost-effectiveness of stenting versus balloon angioplasty for acute myocardial infarction H Suryapranata, J P Ottervanger, E Nibbering, A W J van't Hof, J C A Hoorntje, M J de Boer, M J Al, F Zijlstra

Department of Cardiology, Isala Klinieken, Hospital de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, Netherlands

Correspondence to: Dr Suryapranata h.suryapranata{at}diagram-zwolle.nl

Accepted 23 October 2000

OBJECTIVETo investigate the long term clinical outcome and cost-effectiveness of stenting compared with balloon angioplasty in patients with acute myocardial infarction.
METHODSPatients 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.
RESULTSAfter 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).
CONCLUSIONSCompared 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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© 2001 by Heart
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