title: Safety, efficacy, and cost advantages of combined coronary angiography and angioplasty.
abstract: OBJECTIVE
  The safety and efficacy of ad hoc PTCA has been previously reported and this approach is performed in many angioplasty centers as a routine procedure. The aim of this study is to examine whether this approach reduces the length, and cost of hospital stay.
  
  
  RESULTS
  To determine the hospital costs we studied 2,440 PTCAs over 11 years in our institution (1990-2000). Urgent PTCA for acute coronary syndromes refractory to medical treatment were excluded. In 1809 patients (74%) angioplasty was performed immediately after coronary angiography, while separate procedures were performed in 631 patients. Indication for PTCA was unstable angina in 1342 patients (55%). In the ad hoc PTCA group, 92% of the culprit lesions were successfully treated; complications included myocardial infarction (2%), urgent bypass surgery (0.6%) and death (0.9%). The rate of combined procedure progressively increased from 54% in 1990 to 88% in 2000, with a significant decrease in the rate of complications. After adjusting for clinical and angiographic differences between combined and separate procedures, angiographic success and complication rates were not statistically different in the two groups. Mean length of hospital stay decreased all along the years, and was 45% less in the ad hoc PTCA group (11.4 +/- 6.9 vs 18.2 +/- 7.7 in 1990, 5.4 +/- 4.3 vs 10.8 +/- 5.7 in 2000, P < 0.0001). The cost was 40% lower in the ad hoc PTCA group. For patients with stable angina, the savings were 49%, and for those with unstable angina, they were 29%.
  
  
  CONCLUSIONS
  In the era of coronary stenting, ad hoc PTCA can be performed in most of the patients as safely and successfully as a separate procedure. It reduces the length, and the cost of hospital stay in patients with stable or unstable angina.
authors.affiliation: Service de Cardiologie, Hôpital Necker, Paris, France. claude.lefeuvre@psl.ap-hop-paris.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: Gérard
authors.initials: G
authors.lastname: Helft
authors.forename: Farzin
authors.initials: F
authors.lastname: Beygui
authors.forename: Thierry
authors.initials: T
authors.lastname: Zerah
authors.forename: Edouard
authors.initials: E
authors.lastname: Fonseca
authors.forename: Didier
authors.initials: D
authors.lastname: Catuli
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Batisse
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Metzger
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000639:trends; D003131:Combined Modality Therapy / Q000191:economics; D017023:Coronary Angiography / Q000191:economics* / Q000639:trends; D003327:Coronary Disease / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010297:Paris; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome