title: Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting.
abstract: Morbidity following CABG (coronary artery bypass grafting) is difficult to predict and leads to increased healthcare costs. We hypothesized that pre-operative CMR (cardiac magnetic resonance) findings would predict resource utilization in elective CABG. Over a 12-month period, patients requiring elective CABG were invited to undergo CMR 1 day prior to CABG. Gadolinium-enhanced CMR was performed using a trueFISP inversion recovery sequence on a 1.5 tesla scanner (Sonata; Siemens). Clinical data were collected prospectively. Admission costs were quantified based on standardized actual cost/day. Admission cost greater than the median was defined as 'increased'. Of 458 elective CABG cases, 45 (10%) underwent pre-operative CMR. Pre-operative characteristics [mean (S.D.) age, 64 (9) years, mortality (1%) and median (interquartile range) admission duration, 7 (6-8) days] were similar in patients who did or did not undergo CMR. In the patients undergoing CMR, eight (18%) and 11 (24%) patients had reduced LV (left ventricular) systolic function by CMR [LVEF (LV ejection fraction) <55%] and echocardiography respectively. LE (late enhancement) with gadolinium was detected in 17 (38%) patients. The average cost/day was $2723. The median (interquartile range) admission cost was $19059 ($10891-157917). CMR LVEF {OR (odds ratio), 0.93 [95% CI (confidence interval), 0.87-0.99]; P=0.03} and SV (stroke volume) index [OR 1.07 (95% CI, 1.00-1.14); P=0.02] predicted increased admission cost. CMR LVEF (P=0.08) and EuroScore tended to predict actual admission cost (P=0.09), but SV by CMR (P=0.16) and LV function by echocardiography (P=0.95) did not. In conclusion, in this exploratory investigation, pre-operative CMR findings predicted admission duration and increased admission cost in elective CABG surgery. The cost-effectiveness of CMR in risk stratification in elective CABG surgery merits prospective assessment.
authors.affiliation: British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK. berryc@mail.nih.gov
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.forename: Lukas U
authors.initials: LU
authors.lastname: Zimmerli
authors.forename: Tracey
authors.initials: T
authors.lastname: Steedman
authors.forename: John E
authors.initials: JE
authors.lastname: Foster
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Dargie
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Berg
authors.forename: Anna F
authors.initials: AF
authors.lastname: Dominiczak
authors.forename: Christian
authors.initials: C
authors.lastname: Delles
mesh_terms: D000368:Aged; D003287:Contrast Media; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics*; D003327:Coronary Disease / Q000191:economics / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005682:Gadolinium; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012606:Scotland; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; D005682:Gadolinium