Document Detail


Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting.
MedLine Citation:
PMID:  17999639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Colin Berry; Lukas U Zimmerli; Tracey Steedman; John E Foster; Henry J Dargie; Geoffrey A Berg; Anna F Dominiczak; Christian Delles
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical science (London, England : 1979)     Volume:  114     ISSN:  1470-8736     ISO Abbreviation:  Clin. Sci.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-11     Completed Date:  2008-03-13     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  7905731     Medline TA:  Clin Sci (Lond)     Country:  England    
Other Details:
Languages:  eng     Pagination:  423-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Contrast Media
Coronary Artery Bypass / adverse effects,  economics*
Coronary Disease / economics,  physiopathology,  surgery*
Female
Gadolinium / diagnostic use
Health Resources / utilization*
Health Services Research
Hospital Costs / statistics & numerical data*
Humans
Image Interpretation, Computer-Assisted / methods
Length of Stay
Magnetic Resonance Imaging
Male
Middle Aged
Preoperative Care / methods*
Prognosis
Prospective Studies
Scotland
Ventricular Function, Left
Grant Support
ID/Acronym/Agency:
SCD/01//Chief Scientist Office; //Wellcome Trust
Chemical
Reg. No./Substance:
0/Contrast Media; AU0V1LM3JT/Gadolinium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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