Affiliation:
1. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
Abstract
Background
Transradial percutaneous coronary intervention (
PCI
) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world.
Methods and Results
Using data from a consecutive cohort of 5306 patients undergoing
PCI
in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (
TRI)
and transfemoral intervention. Patients receiving
TRI
(n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo
PCI
for single‐vessel disease, and less likely to undergo
PCI
for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190
US
dollars [$9190]) for
TRI
and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method,
TRI
was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower
PCI
‐related costs (adjusted difference −¥5162 [−$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−$222]). Patients receiving
TRI
had shorter length of stay and were less likely to experience major adverse cardiac events or post‐
PCI
bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina.
Conclusions
Among patients undergoing
PCI
,
TRI
was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
57 articles.
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