Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting

Berry, C. , Zimmerli, L.U., Steedman, T., Foster, J.E., Dargie, H.J., Berg, H.A., Dominiczak, A.F. and Delles, C. (2008) Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting. Clinical Science, 114(6), pp. 423-430. (doi:10.1042/CS20070337)

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Publisher's URL: http://dx.doi.org/10.1042/CS20070337

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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Dargie, Professor Henry and Berry, Professor Colin and Foster, Dr John and Dominiczak, Professor Anna and Delles, Professor Christian and Hopkins, Mrs Tracey
Authors: Berry, C., Zimmerli, L.U., Steedman, T., Foster, J.E., Dargie, H.J., Berg, H.A., Dominiczak, A.F., and Delles, C.
Subjects:R Medicine > R Medicine (General)
R Medicine > RD Surgery
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences
Journal Name:Clinical Science
Publisher:Portland Press
ISSN:0140-8736
Copyright Holders:Copyright © 2008 Portland Press
First Published:First published in Clinical Science 114(6):423-430
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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