Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation

Hartwell, Debbie; Colquitt, Jill L; Loveman, Emma; Clegg, Andrew; Brodin, Hå̊kan; Waugh, Norman; Royle, Pamela; Davidson, Peter; Vale, Luke; Mackenzie, Lisa

doi:10.3310/hta9170

Cited by 76 publications

(51 citation statements)

References 34 publications

(50 reference statements)

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“…Heart attack or myocardial infarction (MI) is one manifestation of cardiovascular disease caused by the blockage of a coronary artery. Primary percutaneous coronary intervention (p-PCI), or primary angioplasty as it is better known, is recommended as the first-line therapy for patients with ST elevation MI [2]. The aim of this treatment is to restore blood flow by physically opening the affected coronary artery.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment with p-PCI offers an even shorter average stay of 3 days which is characterised by multiple transfers across settings. Both the clinical and cost effectiveness of primary angioplasty make it an attractive treatment option [2], but an unintended consequence of the shortened hospital stay is the reduction in opportunities for practitioners to provide patients and their families with health information. In light of these developments current approaches to the provision of health information for MI patients may require review.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The information needs of patients treated with primary angioplasty for heart attack: An exploratory study

Astin¹,

Closs²,

McLenachan³

et al. 2008

Patient Education and Counseling

114

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The information needs of patients treated with primary angioplasty for heart attack: An exploratory study

Astin¹,

Closs²,

McLenachan³

et al. 2008

Patient Education and Counseling

114

View full text Add to dashboard Cite

“…517,518 The evidence from 2 studies was scant for additional benefit of PCI over fibrinolysis for specific subgroups such as post CABG patients or patients with renal failure (LOE 1 519 ; LOE 3 520 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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“…1 The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease.…”

Section: Appendix 1 Appendixmentioning

confidence: 99%

Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease

Mowatt¹,

Cummins²,

Waugh³

et al. 2008

Health Technol Assess

Self Cite

199

127

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Clinical effectiveness and cost-effectiveness of immediate angioplasty for acute myocardial infarction: systematic review and economic evaluation

Cited by 76 publications

References 34 publications

The information needs of patients treated with primary angioplasty for heart attack: An exploratory study

The information needs of patients treated with primary angioplasty for heart attack: An exploratory study

Part 9: Acute Coronary Syndromes

Systematic review of the clinical effectiveness and cost-effectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease

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