| The treatment for acute myocardial infarction (AMI) has entered reperfusion era. It has been proven that thrombolysis and percutenous transluminal coronary angioplasty (PTCA) and stenting ( percutenous coronary intervention, PCI) can open the culprit artery (infarct-related artery), restore blood flow and save jeopardized myocardium. Furthermore, compared with thrombolysis , PCI open the infarction-related artery more rapidly with better reperfusion (TIMI Grade 3 flow) and less residual stenosis , which promote better healing in infarction zone, improvement of left ventricular remodeling , and decrease of morbidity and mortality. The objective of this study is to compare and analyze the effect and cost effectiveness of the basic treatment, thrombolysis and PCI in AMI.Method This is an observing cohort study. Between January 1 of 2000 and December 31 of 2001, we selected 300 consecutive patients who suffered from AMI and were treated with basic treatment or thromblytic or interventional treatment (direct PCI, rescue PCI and selective PCI) respectively. The clinical outcomes and costs during the hospital period and follow-up period were compared.Result (1) In hospital period, the echocardiographic (UCG) examination showed that the percentage of patients with walls' motion was higher in interventional group (39.29%) and direct PCI group (46.00%) than that in basic treatment group (20.41%) and thrombolytic group (24.73%). The rate of dyskinesia was 11.83% in thrombolytic group and higher than that in basic treatment group (4.08%), interventional group (2.38%) and direct PCI group (0). The left ejection fraction (EF) in interventional group (56.35+9.44) was higher than that in basic treatment group (52.28+8.58) and thrombolytic group (52.82+10.21)(p<0.05). Compared with basic treatment group and thrombolystic group, the EF of direct PCI group (56.88+10.47) showed no significant difference. (2) During hospital, 3 and 6 months follow-up, the rates of heart failure in interventional group (19.20%, 13.63% and 7.23% respectively) and in direct PCI group (18.30%, 11.54% and 2.13% respectively) were less than those in basic treatment group (34.80%, 31.58% and 15.22 respectively) and thrombolytic group (32.60%, 26.47% and 18.82% respectively)(p<0.05). At 12 months of Follow-up, the rate of heart failure of basic treatment group (15.38%) is higher than that of thrombolytic group (6.06%), interventional group (4.41%) and in direct PCI group (2.56%)(p<0.05). At 24 months of Follow-up, the heart failure rates of various groups showed no significant difference. (3) In hospital period, the rates of angina and re-infarction were no significant difference among all groups.The rates of acute coronary events during follow-up period also had not significant difference. (4) The mortality during hospital showed no significant difference among various groups. The accumulative mortalities were 25.76% in basic treatment group, 15.56% in thrombolytic group, 6.06% in interventional group and 5.00% in direct PCI group at average 13.32+6.86 months follow-up. The accumulative mortalities in interventional group and direct PCI group were less than that in basic treatment group and thrombolytic group. Between basic treatment group and thrombolytic group, there was no significant difference. The accumulative mortality of patients over 60 years of age in interventional group (8.50%) and in direct PCI group (10.34%) were also less than that in basic treatment group (29.40%) and thrombolytic group (19.42%). (5) During follow-up, the quality of life scores in patients of every group gradually increased. The life scores in interventional group and in direct PCI group were higher than that in basic treatment group and thrombolytic group. The life scores of basic treatment group were the lowest of all the groups. (6) The hospital cost of interventional group( Y 51440.50+16412.02) and direct PCI group ( Y 50749.39+15325.68) were higher than that in basic treatment group( Y 4715.95+2361.73) and thrombolytic group(Y10659.36+6152.66). The cost of... |
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