Comparison of medical resource use and total admission cost in patients with acute myocardial infarction between on-hours visit versus off-hours visit.

The medical expenses for patients with acute myocardial infarction (AMI) has become enormous burden for global healthcare system. In AMI patients, total admission cost for patients with off-hours visit may be higher than those with on-hours visit, because of additional cost for emergent care during off-hours. This study aimed to compare total medical cost in AMI patients between on-hours visit versus off-hours visit. We retrospectively included 368 AMI patients who underwent PCI to the culprit lesion, and divided them into the on-hours group (n = 173) and the off-hours group (n = 195). We compared clinical characteristics, total admission cost, and clinical outcomes between the two groups. The prevalence of Killip class 3/4 was significantly greater in the off-hours group than in the on-hours group. Length of ICU and hospital stay were significantly longer in the off-hours group than in the on-hours group. Total admission cost was significantly higher in the off-hours group [¥1,570,400 (¥1,271,550-¥2,117,090)] than in the on-hours group [¥1,356,270 (¥1,100,990-¥1,957,225)] (P < 0.001). However, multivariate analysis revealed off-hours visit itself was not associated with high total admission cost after adjusting confounding factors. In conclusion, total admission cost was higher in AMI patients with off-hours visit than in those with on-hours visit. However, multivariate logistic regression analysis revealed that the off-hours visit itself was not associated with the highest total admission cost. Off-hours visit itself did not result in higher cost, but severer conditions in AMI patients with off-hours visit resulted in higher cost.

Comparison of the cost in percutaneous coronary intervention between ST-segment elevation myocardial infarction vs. non-ST-segment elevation myocardial infarction.

Percutaneous coronary intervention (PCI) is a standard strategy for non-ST-segment elevation myocardial infarction (NSTEMI) as well as for ST-segment elevation myocardial infarction (STEMI). The device cost for PCI may be more expensive in NSTEMI, because the culprit lesion morphology may be more complex in NSTEMI. This study aimed to compare the total device cost of PCI between STEMI and NSTEMI. We included 504 patients with acute myocardial infraction (AMI) who underwent PCI, and divided those into a STEMI group (n = 286) and a NSTEMI group (n = 218). We compared the total device cost, the number of used devices, and procedure cost between the 2 groups. The total device cost was significantly higher in the NSTEMI group [¥371,300 (¥320,700-503,350)] than in the STEMI group [¥341,200 (¥314,200-410,475)] (p = 0.001), whereas the procedure cost was significantly higher in the STEMI group [¥343,800 (¥243,800-343,800)] than in the NSTEMI group [¥220,000 (¥216,800-243,800)] (p < 0.001). Drug eluting stent (85.3% vs. 76.1%, p = 0.029) and aspiration catheter (16.8% vs. 2.3%, p < 0.001) were more frequently used in the STEMI group, whereas rotablator (0.7% vs. 8.3%, p < 0.001) were more frequently used in the NSTEMI group. The multivariate logistic regression analysis revealed that NSTEMI was significantly associated with the high device cost (odds ratio 1.899, 95% confidence interval 1.166-3.093, p = 0.01). In conclusion, the total device cost for PCI was significantly higher in the culprit lesions of NSTEMI than in those of STEMI, whereas the procedure cost was significantly higher in the culprit lesions of STEMI than in those of NSTEMI.