Cost Effectiveness Evaluation of Transradial Versus Transfemoral Access For Emergent Percutaneous Coronary Intervention In Patients With St Elevation Myocardial Infarction

OBJECTIVES: Emergent percutaneous coronary artery intervention (e-PCI) is an effective therapy to restore blocked heart blood flow in patients with ST segment elevation myocardial infarction (STEMI). This technique is clasically performed through femoral artery access (FAA), or recently radial access (RA). Previous evidence in selected low risk patients suggest better clinical outcomes for radial access by reducing access site complications with promising data on cost reduction. There is no study in real life high risk patients with clinical outcomes and economical evaluation, so we developed an economic evaluation to compare FAA and RA procedures. METHODS: A single-center retrospective observational study was carried out with 387 consecutive STEMI patients who underwent e-PCI from 2006 to 2014 with no clinical exclusion criteria. Clinical endpoints were procedural success, access site crossover, mortality, length of in-hospital stay and complication rate. Economical endpoints were total cost and costs by category at hospital setting. Hospital's perspective was adopted with micro costing bottom-up method. Average costs were obtained from the hospital's accounting system and other Health Care data bases. A discount rate of 3% per year was applied. Depending on the different type of variables Student's t test, chi-square, Fischer's exact tests and linear regression were used. To determine independent predictor factors logistic regression was carried out. Bootstrapping was performed with 1000 iterations for robustness and sensitivity analysis RESULTS: A significant reduction >20% (OR=0.29,95% CI 0.16 to 0.48;p=0.00) in complication rates favoring RA group (cardiac, vascular, bleeding and in-hospital infection) was found with an average saving of3875f [95% bootstrapped CI 1590,46 to 6098,17;p=0.001)] per procedure with radial access. CONCLUSIONS: In e-PCI setting of STEMI there is a clinical outcome improvement (reduced procedure related mortality and complications) and cost reduction if radial access is used, being a dominant (more effective and less costly) strategy compared to FAA in our hospital real life cost-effectiveness study.