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In this presentation, we look at cost benefits of angioplasties as they relate to other treatments for myocardial infarcts.
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By Shawn Pichette
Caused by the formation of plaques within arteries• Plaque is made up of
macrophages• Cholesterol crystals• Calcification
Advances in Atherosclerosis are chronic, slowly progressive, and cumulative
Leads to thrombus (blood clot)
Leads to myocardial infarction (heart attack)
EARLY INTERVENTION LATER INTERVENTION
Cessation of smoking/ diet/ exercise
Statins (Lipitor, Crestor, Etc.)
Dietary supplements: Niacin (Vitamin B3), Omega-3 Fatty Acids, Other Vitamins (C, E, and K2)
Beta Blockers Ace Inhibitors
Antiplatelet Agents (Plavix)
Thrombolytic Therapy Coronary Artery Bypass
Surgery Primary Coronary
Intervention - Angioplasty
“Any endovascular procedure that reopens narrowed blood vessels and restores forward blood flow” (Taber’s Cyclopedic Medical Dictionary)
Utilizes a stent that is inflated to a fixed size using water pressure from 75 to 500 times normal blood
pressure
Generally performed on coronary, carotid, or peripheral artery
Thrombolytic Agents
Open Heart Surgery
Plavix Angioplasty
Invasive? No Yes No Yes
Adverse Events
Intracranial Hemorrhage, Fever, Irregular Heartbeat, Low Blood Pressure, Allergic Reaction to Streptokinase
Stroke, Myocardial Infarction, Acute Renal Failure, Stenosis, Nonunion of Sternum, General Surgical Complications
GI Hemmorhage (2% Incidence),Neutropenia (0.05% Incidence)
Ischemia, Stroke, Myocardial Infarction, aortic dissection
Performed By:
Physician (or Under Physician’s Supervision, Nurse Practitioner
Cardiovascular Surgeon, Cardiovascular Anesthesiologist, Etc.
Patient Orally (Prescription Required)
Interventional Cardiologist; Trained MD
Failure Rate in MI
~ 20% 5 – 10% - < 5%
Cost $11,788-$14,438 $44,000-$60,000 $448.02 for 90 75mg tablets ARP
$94,000
Duke University Study• Compared angioplasties to medical therapy
alone in high risk patients
Used Duke Activity Status Index to measure patient outcomes
Also used cost effectiveness
Angioplasty group showed better health outcomes after four months
Both groups showed similar health outcomes at one to two years
Angioplasty group costs were over $7,000 higher than medical therapy group over two years
Where and when can one get an angioplasty/ bypass/ thrombolytic agent?• For example, rural areas, time of day, day of week• Quality of surgeons in local hospital
What is the tradeoff for failure rate vs. cost?• Also long term vs. short term treatment
How long term should long term be?• Note age of patient• Other diseases that patient may have
Even at its high cost, angioplasties are the best treatment for most patients suffering from atherosclerosis or myocardial infarction, especially in short term
It may not be economical in certain situations• For example, patients with cancer
It may not be possible in some situations• For example, patients in rural areas
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