715-3 Cost Implications of Aortic Counterpulsation in Acute Myocardial Infarction: Results from a Randomized Clinical Trial

To evaluate the cost implications of prophylactic aortic counterpulsation (IASP) to sustain coronary artery patency during acute myocardial infarction. we evaluated 102 (55%) from the 182 patients enrolled in the randomized IABP study. After coronary artery patency was established during acute cardiac catheterization, pts were randomized to IABP (N=52) for 48 hours versus standard therapy, Control (C) = 50. During the hospitalization. pts with IASP had less recurrent ischemia (4% vs. 21%), less reinfarction (3% vs. 8%), less reocclusion (8% vs. 21%), and less need for emergency PTCA (2% vs. 11%). The duration of hospitalization (IABP = 104vs. C = 9.7 daysl and CCU stay (IABP = 4.7 vs. C = 3.9 days) were similar. The outcomes were similar in the sUbstudy compared with the overall clinical trial. Median costs were:Cath Lab $CCU/ICU $Non-ICU $Total $IABP5,9103,2391,80417,903Control5,6792,7811,85117,913The cost of hospitalization was significantly greater in pts with recurrent ischemia ($21,069vs. $17,492, p = 0.02) or reinfarction ($22,772 vs. $17,721, p = 0.06) compared with patients without these complications.ThusThese findings suggest that a strategy of prophylactic IASP therapy after patency has been established during acute myocardial infarction while improving clinical outcomes does not increase hospitalization cost