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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