ObjectivesTo evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart).DesignCost-utility analysis.SettingThe analysis was from the ...Catalonian Autonomous Community in Spain, with a population of about 7.5 million people.ParticipantsPatients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries.Outcome measuresCosts included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140).ResultsA substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30 000, results were sensitive to variations in costs and outcomes.ConclusionsThe Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.
El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no está claro. El objetivo de este estudio es evaluar los cambios en el ...tratamiento del IAMCEST durante el brote de COVID-19.
Se utilizó un registro multicéntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las características de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes según se los hubiera tratado antes o durante la COVID-19.
Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusión (más del 94% tratados con angioplastia primaria). El tiempo de isquemia fue más largo durante la COVID-19 (233 150-375 frente a 200 140-332 min; p <0,001), sin diferencias en el tiempo primer contacto médico-reperfusión. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta=1,50; IC95%, 1,07-2,11; p <0,001); esta asociación se mantuvo tras ajustar por factores de confusión (OR ajustada=1,88; IC95%, 1,12-3,14; p=0,017). La incidencia de infección confirmada por SARS-CoV-2 fue del 6,3%.
El brote de COVID-19ha implicado una disminución en el número de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los síntomas y la reperfusión y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusión. La combinación de infección por SARS-CoV-2 e IAMCEST fue relativamente infrecuente.
The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.
Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.
Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 150-375 vs 200 140-332 minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.
The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI ...management during the COVID-19 outbreak.
Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.
Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 150-375 vs 200 140-332 minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.
The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no está claro. El objetivo de este estudio es evaluar los cambios en el tratamiento del IAMCEST durante el brote de COVID-19.
Se utilizó un registro multicéntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las características de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes según se los hubiera tratado antes o durante la COVID-19.
Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusión (más del 94% tratados con angioplastia primaria). El tiempo de isquemia fue más largo durante la COVID-19 (233 150-375 frente a 200 140-332 min; p <0,001), sin diferencias en el tiempo primer contacto médico-reperfusión. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta=1,50; IC95%, 1,07-2,11; p <0,001); esta asociación se mantuvo tras ajustar por factores de confusión (OR ajustada=1,88; IC95%, 1,12-3,14; p=0,017). La incidencia de infección confirmada por SARS-CoV-2 fue del 6,3%.
El brote de COVID-19ha implicado una disminución en el número de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los síntomas y la reperfusión y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusión. La combinación de infección por SARS-CoV-2 e IAMCEST fue relativamente infrecuente.
PDF
