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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Sodium Nitrite-Mediated Cardioprotection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation
Daniel A Jones1,2,3, Peter Whittaker3,4, Krishnaraj S Rathod1,2
11 Barts NIHR Biomedical Research Centre, Barts and The London Medical School, Queen Mary University, London, United Kingdom.
Insights
Sodium nitrite therapy during primary percutaneous coronary intervention for acute myocardial infarction significantly reduced major adverse cardiac events and demonstrated cost-effectiveness, offering potential economic benefits alongside improved patient outcomes.
Area of Science:
- Cardiology
- Health Economics
- Pharmacology
Background:
- Acute myocardial infarction (AMI) management involves primary percutaneous coronary intervention (PCI).
- Sodium nitrite administered during primary PCI showed reduced major adverse cardiac events (MACEs) in AMI patients.
- Economic implications of sodium nitrite's cardioprotective effects require assessment.
Purpose of the Study:
- To evaluate the cost-utility of sodium nitrite therapy compared to standard primary PCI in AMI patients.
- To analyze the economic benefits associated with reduced MACE rates observed with sodium nitrite treatment.
Main Methods:
- A decision tree model simulated costs and quality-adjusted life years (QALYs) over 36 months post-ST-Segment Elevation Myocardial Infarction (STEMI).
- Model inputs were derived from the NITRITE-AMI study, with costs calculated from a UK National Health Service perspective.
- Comparative treatments and follow-up costs related to cardiovascular events were analyzed.
Main Results:
- Sodium nitrite treatment resulted in higher utility values (0.91 vs 0.82) and lower costs for repeat revascularization, myocardial infarction, and heart failure hospitalizations.
- The incremental cost-effectiveness ratio was £2177 per QALY, indicating a cost-effective strategy.
- The model demonstrated robustness, with cost-effectiveness maintained even with a four-fold increase in nitrite cost.
Conclusions:
- Sodium nitrite demonstrates cost-effectiveness as a cardioprotective treatment following AMI.
- Further comparative analyses and longer follow-up studies are warranted.
- Nitrite-mediated cardioprotection holds considerable potential for improving patient outcomes and reducing healthcare costs.
Objectives:
In the follow-up of patients in a trial of intracoronary sodium nitrite given during primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI), we found a reduction in the incidence of major adverse cardiac events (MACEs). Specifically, MACE rates were 5.2% versus 25.0% with placebo at 3 years ( P = .013). Such MACE reductions should also be associated with economic benefit. Thus, we assessed the cost utility of sodium nitrite therapy versus standard primary PCI only.
Methods And Results:
We developed a model to simulate costs and quality-adjusted life years (QALYs) over the first 36 months after ST-Segment Elevation Myocardial Infarction (STEMI). Decision tree analysis was used to assess different potential cardiovascular outcomes after STEMI for patients in both treatment groups. Model inputs were derived from the NITRITE-AMI study. Cost of comparative treatments and follow-up in relation to cardiovascular events was calculated from the United Kingdom National Health Service perspective. Higher procedural costs for nitrite treatment were offset by lower costs for repeat revascularization, myocardial infarction, and hospitalization for heart failure compared to primary PCI plus placebo. Nitrite treatment was associated with higher utility values (0.91 ± 0.19 vs 0.82 ± 0.30, P = .041). The calculated incremental cost-effectiveness ratio of £2177 per QALY indicates a cost-effective strategy. Furthermore, positive results were maintained when input parameters varied, indicating the robustness of our model. In fact, based on the difference in utility values, the cost of nitrite could increase by 4-fold (£2006 per vial) and remain cost-effective.
Conclusion:
This first analysis of sodium nitrite as a cardioprotective treatment demonstrates cost-effectiveness. Although more comparative analysis and assessment of longer follow-up times are required, our data indicate the considerable potential of nitrite-mediated cardioprotection.
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