Maher, Ali
Department of Health Care Administration, North Tehran Branch, Islamic Azad University, Tehran, Iran

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Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran Alimohammadzadeh, Khalil; Sadeghi, Roxana; Maher, Ali; Kazemi, Mohammad Kazem
International Journal of Cardiovascular Practice Vol 2, No 3 (2017)
Publisher : International Journal of Cardiovascular Practice

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (118.54 KB) | DOI: 10.21859/ijcp-020305

Abstract

  Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI) versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI).Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase) needs to be discussed.Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events) including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction) was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02). Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05). Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01).Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy seems to represent a safe alternative to PPCI. Higher costs for patients with PPCI may be decreased with shorter duration of hospital stays according to guidelines.
Short-and Long–Term Follow–up in the Elderly Patients With ST–Elevation Myocardial Infarction Receiving Primary Angioplasty or Thrombolytic Therapy Kazemi, Mohammad Kazem; Alimohammadzadeh, Khalil; Maher, Ali
International Journal of Cardiovascular Practice Vol 4, No 1 (2019)
Publisher : International Journal of Cardiovascular Practice

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (529.057 KB) | DOI: 10.21859/ijcp-403

Abstract

Introduction: The ischemic time serves as the most important parameter for treatment choice in patients with ST–elevation myocardial infarction (STEMI). The current study aimed at comparing the short– and long–term follow–up of elderly patients with STEMI undergoing primary angioplasty (PCI) or thrombolytic therapy.Methods: The current cross sectional study was conducted on all patients aged >65 years, admitted to the emergency department of Imam Hossein Hospital, Tehran, Iran from January 2014 to July 2016, diagnosed with STEMI . The demographics, medical history, family history, and mediation history were recorded for all patients. Patients received PCI or thrombolytic therapy based on the ischemic time and the treatment outcome and the following events were recorded. Patients were contacted after six months and data of their death or used treatments were recorded. All data were compared between the groups.Results: Of all patients, 38 subjects received thrombolytic therapy and 62 PCI. There was no significant difference between the groups in terms of mean age and gender (P=0.5 and 0.1, respectively). The frequency of positive medical history and smoking did not differ between the groups. There was no difference in the mean values of vital signs or serum parameters, mean ischemic time, left ventricular ejection fraction (LVEF), frequency of pulmonary emboli, cardiogenic shock, the involved vessel, and post-treatment complications between the groups (P>0.05). Of the 14 cases that died after six months, five were in the thrombolytic therapy group and nine in the PCI group (P=0.8). Mean hospital stay was not different between the groups (P=0.5).Conclusions: The results of the present study on two groups with similar demographics showed no significant difference between the groups in terms of the short– and long–term follow–up of PCI and thrombolytic therapy. The results indicated the appropriateness of treatment choice based on ischemic time and the available methods.