Introduction
Methods
Study population
Outcomes
Statistical analysis
Results
Before propensity score matching | After propensity score matching | |||||
---|---|---|---|---|---|---|
Conventional | ELCA | p value | Conventional | ELCA | p value | |
Variables | (n = 89) | (n = 104) | (n = 71) | (n = 71) | ||
Age years | 69.91 ± 14.48 | 67.35 ± 13.77 | 0.209 | 68.52 ± 14.67 | 67.9 ± 14.17 | 0.798 |
Sex category, male, % | 63 (70.8) | 80 (76.9) | 0.322 | 51 (71.8) | 55 (77.5) | 0.440 |
Smoker, % | 43 (48.9) | 56 (53.8) | 0.491 | 36 (50.7) | 39 (54.9) | 0.614 |
Diabetes, % | 28 (31.5) | 27 (26.0) | 0.399 | 24 (33.8) | 20 (28.2) | 0.468 |
Hypertension, % | 56 (62.9) | 55 (52.9) | 0.160 | 46 (64.8) | 39 (54.9) | 0.231 |
Dyslipidemia, % | 41 (46.1) | 51 (49.0) | 0.680 | 34 (47.9) | 36 (50.7) | 0.737 |
Antiplatelets use, % | 24 (27.0) | 24 (23.1) | 0.533 | 20 (28.2) | 15 (21.1) | 0.330 |
Statins use, % | 23 (25.8) | 22 (21.2) | 0.443 | 18 (25.4) | 13 (18.3) | 0.310 |
ACEs / ARBs use, % | 29 (32.6) | 25 (24.0) | 0.187 | 23 (32.4) | 18 (25.4) | 0.355 |
β blockers use, % | 13 (14.6) | 15 (14.4) | 0.971 | 12 (16.9) | 9 (12.7) | 0.478 |
STEMI, % | 63 (70.8) | 79 (76.0) | 0.416 | 54 (76.1) | 54 (76.1) | 1.000 |
LVEF, % | 49.7 ± 13.23 | 50.57 ± 12.57 | 0.632 | 48.8 ± 13.3 | 49.1 ± 12.7 | 0.904 |
Shock, % | 12 (13.5) | 15 (14.4) | 0.851 | 11 (15.5) | 10 (14.1) | 0.813 |
Door-to-balloon time, min | 676.51 ± 173.21 | 146.63 ± 31.11 | 0.003 | 147.92 ± 15.5 | 136.4 ± 19.1 | 0.640 |
Onset-to-door time, min | 448.86 ± 571.81 | 506.63 ± 1119.03 | 0.705 | 435.58 ± 581.80 | 523.75 ± 1329.09 | 0.652 |
MI location | ||||||
Inferior, % | 36 (40.4) | 37 (35.6) | 0.318 | 28 (39.4) | 24 (33.8) | 0.208 |
Posterior, % | 6 (6.7) | 8 (7.7) | 5 (7.0) | 5 (7.0) | ||
Anterior, % | 43 (48.3) | 47 (45.2) | 34 (47.9) | 34 (47.9) | ||
Lateral, % | 4 (4.5) | 12 (11.5) | 4 (5.6) | 8 (11.3) | ||
Troponin I μg/ml | 32.83 ± 10.6 | 53.12 ± 17.7 | 0.346 | 37.58 ± 13.1 | 43.9 ± 20.2 | 0.792 |
KILLIP classification | ||||||
I or II, % | 72 (80.9) | 88 (84.6) | 0.494 | 56 (78.9) | 56 (78.9) | 1.000 |
III or IV, % | 17 (19.1) | 16 (15.4) | 15 (21.1) | 15 (21.1) | ||
Initial TIMI grade | ||||||
0, % | 44 (50.0) | 45 (43.3) | 0.641 | 37 (52.1) | 40 (56.3) | 0.740 |
1, % | 7 (8.0) | 6 (5.8) | 7 (9.9) | 4 (5.6) | ||
2, % | 15 (17.0) | 20 (19.2) | 11 (15.5) | 9 (12.7) | ||
3, % | 22 (25.0) | 33 (31.7) | 16 (22.5) | 18 (25.4) | ||
Final TIMI grade | ||||||
0, % | 2 (2.2) | 0 (0.0) | 0.311 | 2 (2.8) | 0 (0.0) | 0.328 |
1, % | 1 (1.1) | 1 (1.0) | 1 (1.4) | 1 (1.4) | ||
2, % | 1 (1.1) | 0 (0.0) | 1 (1.4) | 0 (0.0) | ||
3, % | 85 (95.5) | 103 (99.0) | 67 (94.4) | 70 (96.5) |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p value | OR | 95% CI | p value | |
Age | 1.052 | 1.006–1.101 | 0.026 | 1.068 | 1.009–1.131 | 0.024 |
Sex category, male | 0.364 | 0.125–1.062 | 0.064 | |||
Current smoker | 0.314 | 0.096–1.023 | 0.055 | |||
Diabetes | 1.280 | 0.417–3.932 | 0.666 | |||
Hypertension | 0.722 | 0.232–2.250 | 0.574 | |||
Dyslipidemia | 0.250 | 0.068–0.916 | 0.036 | |||
Statins use (pre-PCI) | 1.215 | 0.367–4.020 | 0.750 | |||
ACEs/ARBs use (pre-PCI) | 0.931 | 0.283–3.060 | 0.906 | |||
Anterior MI | 0.746 | 0.255–2.184 | 0.593 | |||
LVEF | 0.909 | 0.866–0.954 | < 0.001 | 0.915 | 0.866–0.968 | 0.012 |
Cardiogenic shock | 9.564 | 3.119–29.324 | < 0.001 | 12.261 | 1.693–88.821 | 0.013 |
Door-to-balloon time | 1.000 | 1.000–1.000 | 0.599 | |||
Cardiac troponin I | 1.002 | 1.000–1.004 | 0.119 | |||
KILLIP classification (> = III) | 9.625 | 3.144–29.469 | < 0.001 | 7.635 | 1.376–42.373 | 0.020 |
Initial TIMI grade | 0.674 | 0.424–1.071 | 0.095 | |||
Final TIMI grade | 0.539 | 0.227–1.278 | 0.161 | |||
ELCA | 0.191 | 0.052–0.699 | 0.012 | 0.176 | 0.039–0.792 | 0.024 |
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p value | OR | 95% CI | p value | |
Age | 1.039 | 0.991–1.089 | 0.110 | |||
Sex category, male | 0.653 | 0.184–2.313 | 0.509 | |||
Current smoker | 0.269 | 0.069–1.037 | 0.057 | |||
Diabetes | 1.125 | 0.320–3.953 | 0.854 | |||
Hypertension | 0.446 | 0.134–1.483 | 0.188 | |||
Dyslipidemia | 0.080 | 0.010–0.641 | 0.017 | 0.077 | 0.007–0.805 | 0.032 |
Statins use (pre-PCI) | 1.214 | 0.308–4.788 | 0.781 | |||
ACEs/ARBs use (pre-PCI) | 0.467 | 0.098–2.229 | 0.339 | |||
Anterior MI | 0.760 | 0.229–2.517 | 0.653 | |||
LVEF | 0.888 | 0.835–0.943 | < 0.001 | 0.890 | 0.828–0.957 | 0.002 |
Cardiogenic shock | 11.600 | 3.243–41.496 | < 0.001 | 6.494 | 1.228–34.34 | 0.028 |
Door-to-balloon time | 0.999 | 0.994–10..4 | 0.622 | |||
Cardiac troponin I | 1.002 | 1.000–1.005 | 0.074 | |||
KILLIP classification (> = III) | 9.818 | 2.717–35.483 | < 0.001 | |||
Initial TIMI grade | 0.733 | 0.430–1.250 | 0.255 | |||
Final TIMI grade | 0.555 | 0.232–1.326 | 0.185 | |||
ELCA | 0.177 | 0.037–0.839 | 0.029 | 0.147 | 0.022–0.959 | 0.045 |
Discussion
Devices | Cost | |
Aspiration catheter | ¥40,800 | |
Filter wire set | ¥119,000 | |
Total | ¥159,800 | |
Laser catheter | ¥211,000 | |
Incremental cost | ¥51,200 | |
Cost | Alive | |
Conventional | ¥159,800 × 71 | 61 |
ELCA | ¥211,000 × 71 | 69 |
ICER = (¥51,200 × 71)/(69 − 91) = ¥454,400 ≈ 4,200 USD (per lifesaving) |