FROM HEARTWIRE..

ACUTE CORONARY SYNDROMES

Taking patients directly to existing PCI centers is more cost-effective than expanding PCI capacity

JULY 28, 2010 | Reed Miller

Boston, MA - Improving the ability of emergency medical services (EMS) to move ST-segment-elevation-MI (STEMI) patients directly to existing PCI facilities is a more cost-effective regional strategy than building and staffing more PCI labs, a new computer simulation study shows [1].

In a study published online July 27, 2010 in Circulation: Cardiovascular Quality and Outcomes, Dr Thomas Concannon (Tufts University, Boston, MA) and colleagues estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with STEMI who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system in Dallas County, TX.

PCI is generally more effective than fibrinolytic therapy for the treatment of STEMI, but most US hospitals are not equipped for PCI. Because the cost/benefit ratio of delaying any treatment in order to reach a PCI lab is different for each patient, depending on where they are and their specific condition, Concannon et al's model examined each case, Concannon told heartwire. "And in a county of pretty significant size, we were able to show that EMS detection and diversion would work better than hospital construction."

The researchers compared a base case strategy of no new construction or staffing with several different hospital-based strategies that entailed building new PCI laboratories or extending the hours of existing laboratories and then compared all of those strategies with a system in which EMS transported all STEMI patients to the existing PCI-capable hospitals.

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