Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting.
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.
Berry
Colin
C
British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK. berryc@mail.nih.gov
Zimmerli
Lukas U
LU
Steedman
Tracey
T
Foster
John E
JE
Dargie
Henry J
HJ
Berg
Geoffrey A
GA
Dominiczak
Anna F
AF
Delles
Christian
C
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
D003287:Contrast Media; D005682:Gadolinium