Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs (original) (raw)

Abstract

Objectives

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 ≤ 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.

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Abbreviations

CABG:

Coronary artery bypass grafting

DRG:

Diagnosis related group

EF:

Ejection fraction (left ventricular)

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

CCS:

Canadian cardiovascular society

BMI:

Body mass index

ACS:

Acute coronary syndrome

LV:

Left ventricular

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Acknowledgments

The authors are indebted to Mr. Ing. (grad.) Klaus Balkenhoff for establishing the PCI database. We thank all technicians and nurses in the catheterization laboratories of the Department of Cardiology and Angiology of the Hospital of the University of Münster, Münster, Germany, for their ongoing support.

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Authors and Affiliations

  1. Hospital of the University of Münster, Münster, Germany
    Michele Pohlen, Holger Bunzemeier MD, Wibke Husemann MD, Norbert Roeder MD, Günter Breithardt MD, FESC, FACC, FHRS & Holger Reinecke MD
  2. Department of Cardiology and Angiology, Medizinische Klinik und Poliklinik C, Universitätsklinikum Münster, 48129, Münster, Germany
    Michele Pohlen, Wibke Husemann MD, Günter Breithardt MD, FESC, FACC, FHRS & Holger Reinecke MD
  3. DRG-Research Group, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
    Holger Bunzemeier MD & Norbert Roeder MD

Authors

  1. Michele Pohlen
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  2. Holger Bunzemeier MD
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  3. Wibke Husemann MD
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  4. Norbert Roeder MD
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  5. Günter Breithardt MD, FESC, FACC, FHRS
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  6. Holger Reinecke MD
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Corresponding author

Correspondence toHolger Reinecke MD.

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Pohlen, M., Bunzemeier, H., Husemann, W. et al. Risk predictors for adverse outcomes after percutaneous coronary interventions and their related costs.Clin Res Cardiol 97, 441–448 (2008). https://doi.org/10.1007/s00392-008-0647-8

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