Costs and benefits associated with transradial versus transfemoral percutaneous coronary intervention in China

Chen Jin, Wei Li, Shu Bin Qiao, Jin Gang Yang, Yang Wang, Pei Yuan He, Xin Ran Tang, Qiu Ting Dong, Xiang Dong Li, Hong Bing Yan, Yong Jian Wu, Ji Lin Chen, Run Lin Gao, Jin Qing Yuan, Ke Fei Dou, Bo Xu, Wei Zhao, Xue Zhang, Ying Xian, Yue Jin Yang

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article numbere002684
JournalJournal of the American Heart Association
Volume5
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Coronary artery disease
  • Cost
  • Health services research
  • Interventional cardiology
  • Outcomes research
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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