Intravascular ultrasound and angiography during percutaneous coronary intervention in patients with acute myocardial infarction: survival and cost-effectiveness analysis (one-year follow-up)

Aim. To determine the number of years of lost life (YLL) as a result of not using intravascular ultrasound (IVUS) during percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI), as well as to conduct a costeffectiveness analysis.

Material and methods. This randomized controlled study included 431 patients with acute STEMI treated at the Department of X-ray Surgical Diagnostic and Treatment Methods of the Vsevolozhsk Clinical Interdistrict Hospital. Patients of the first group (n=161) underwent IVUS-guided PCI, while patients of the second group (n=270) — angiography-guided PCI. The inclusion criterion was electrocardiographic changes corresponding to acute STEMI, followed by coronary angiography confirmation. Patients with cardiogenic shock were excluded from the study due to expected higher rates of inhospital and one-year mortality compared to patients with acute STEMI without cardiogenic shock. Traditional life tables were constructed, and an analysis of differences in death probability within one year after surgery was performed. A model was constructed showing the number of lives could have been saved if all patients in the PCI angiography group had been supplemented with IVUS. The number of patients who need to be treated to prevent one adverse outcome and the cost of life-years saved due to the implementation of IVUS were calculated.

Results. Not using IVUS for coronary artery stenting in patients with acute STEMI (n=270) potentially results in YLL losses of 117,3 personyears. The number of patients who need to be treated to prevent one adverse outcome was 12,9 (95% confidence interval: 7,3-104). The cost of one saved person-year of life for the regional Ministry of Health was RUB 195 666 in the analyzed period. At the same time, the increase in costs for one additional life saved during the year is RUB 1 105 000.

Conclusion. IVUS in patients with acute STEMI has high economic potential and social orientation in a long-term analysis.

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