Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs.
OBJECTIVE
During recent years, numerous clinical and procedural risk factors for adverse outcomes after percutaneous coronary interventions (PCI) have been identified. Due to the high economic pressure in many national health care systems, it is of some interest whether these predictors of clinical risks represent also the main cost drivers.


METHODS
Data of 770 patients undergoing PCI were retrospectively analyzed. Risk factors for PCI as well as angiographic classifications were adopted from the ACC/AHA Guidelines. In-hospital costs for each patient were obtained from thoroughly performed calculations for the national Diagnosis Related Groups database in Germany.


RESULTS
Creatinine >2 mg/dl (192% of average costs, P < 0.0001), EF <or= 35% (146%, P < 0.0001), presence of a thrombus (146%, P < 0.0001), PCI of a venous bypass (143%, P < 0.0001), CCS class IV (123%, P < 0.0001), coronary three-vessel disease (119%, P < 0.0001) and age (112%, P = 0.014) were associated with both higher in-hospital mortality and costs. Furthermore, in patients with acute coronary syndromes the time delay from onset of symptoms until PCI had marked impact on costs.


CONCLUSIONS
Most predictors for adverse outcome after PCI were also found to be major cost drivers. Moreover, time delay from onset of ACS to PCI had marked impact on costs and should be implemented in the reimbursement systems.
Pohlen
Michele
M
Hospital of the University of Münster, Münster, Germany.
Bunzemeier
Holger
H
Husemann
Wibke
W
Roeder
Norbert
N
Breithardt
Günter
G
Reinecke
Holger
H
D054058:Acute Coronary Syndrome / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics*; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D003365:Costs and Cost Analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D003404:Creatinine