Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China.
BACKGROUND: Transradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world. METHODS AND RESULTS: Using data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in-hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single-vessel disease, and less likely to undergo PCI for triple-vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI-related costs (adjusted difference -¥5162 [-$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (-¥1399 [-$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post-PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina. CONCLUSIONS: Among patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.
Jin, C; Li, W; Qiao, S-B; Yang, J-G; Wang, Y; He, P-Y; Tang, X-R; Dong, Q-T; Li, X-D; Yan, H-B; Wu, Y-J; Chen, J-L; Gao, R-L; Yuan, J-Q; Dou, K-F; Xu, B; Zhao, W; Zhang, X; Xian, Y; Yang, Y-J
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