Cost Advantages of an Ad Hoc Angioplasty Strategy

Adele, Chituru; Vaitkus, Paul T.; Wells, Susannah K.; Zehnacker, Jonathan B

doi:10.1016/s0735-1097(97)00512-3

Cited by 25 publications

(29 citation statements)

References 15 publications

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“…Furthermore, at least theoretically, ad hoc PCI is cost-saving for both the patients and society. 23 Therefore, we have good reasons to promote ad hoc PCI in patients with stable CAD.…”

Section: Discussionmentioning

confidence: 99%

Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

Takahashi

Morimoto

Shiomi

et al. 2017

Circ J

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Background: Few studies have evaluated the prevalence and clinical outcomes of ad hoc percutaneous coronary intervention (PCI), performing diagnostic coronary angiography and PCI in the same session, in stable coronary artery disease (CAD) patients. Methods and Results:From the CREDO-Kyoto PCI/CABG registry cohort-2, 6,943 patients were analyzed as having stable CAD and undergoing first PCI. Ad hoc PCI and non-ad hoc PCI were performed in 1,722 (24.8%) and 5,221 (75.1%) patients, respectively. The cumulative 5-year incidence and adjusted risk for all-cause death were not significantly different between the 2 groups (15% vs. 15%, P=0.53; hazard ratio: 1.15, 95% confidence interval: 0.98-1.35, P=0.08). Ad hoc PCI relative to non-ad hoc PCI was associated with neutral risk for myocardial infarction, any coronary revascularization, and bleeding, but was associated with a trend towards lower risk for stroke (hazard ratio: 0.78, 95% confidence interval: 0.60-1.02, P=0.06). Conclusions:Ad hoc PCI in stable CAD patients was associated with at least comparable 5-year clinical outcomes as with non-ad hoc PCI. Considering patients' preference and the cost-saving, the ad hoc PCI strategy might be a safe and attractive option for patients with stable CAD, although the prevalence of ad hoc PCI was low in the current study population.

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“…Furthermore, at least theoretically, ad hoc PCI is cost-saving for both the patients and society. 23 Therefore, we have good reasons to promote ad hoc PCI in patients with stable CAD.…”

Section: Discussionmentioning

confidence: 99%

Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

Takahashi

Morimoto

Shiomi

et al. 2017

Circ J

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“…Coronary intervention performed at the time of diagnostic catheterization has variously been termed "ad hoc" [11,12], "prima vista" [7], "combined" [6,9,13,14], and "single-stage" [15,16] PCI. Among published studies, there is no consistent definition of this process.…”

Section: Definitions Of Ad Hoc and Separate Pcimentioning

confidence: 99%

“…Adele et al [11] performed an economic analysis of 395 patients undergoing ad hoc PCI, which included 191 (48%) who underwent stenting. Complications occurred in 7.4% of the ad hoc group versus 4.2% when the procedures were performed separately, a difference that lacked statistical significance, although the study was not powered to identify differences in success or complication rates.…”

Section: Studies Of Ad Hoc Versus Separate Pci In Stent Eramentioning

confidence: 99%

“…However, their charge data may not have accurately represented actual costs, and findings from the prestent era may not apply to the stent era. Adele et al [11] found that ad hoc PCI for stented patients, but not angioplastied patients, was significantly less costly than staged procedures. Specifically, the cost of the average ad hoc stent procedure was $8,808, but when performed separately from a diagnostic procedure, the cost combined was $10,737.…”

Section: Cost Comparisons Of Ad Hoc Versus Separate Interventionmentioning

confidence: 99%

“…In contrast, the average ad hoc balloon angioplasty cost was not different from the average cost of separate diagnostic angiography and angioplasty in all groups. Adele et al [11] concluded that there were significantly lower costs with an ad hoc strategy when stenting was used.…”

Section: Cost Comparisons Of Ad Hoc Versus Separate Interventionmentioning

confidence: 99%

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SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

Blankenship

Klein

Laskey

et al. 2004

Cathet Cardio Intervent

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Coronary intervention may be combined with diagnostic cardiac catheterization or performed separately. In the early years of angioplasty, performing these procedures separately was standard practice. Gradually, ad hoc intervention (performing diagnostic angiography and coronary intervention within the same session) has become more common, largely because of its convenience for patients and efficiency for physicians. However, the safety and potential cost savings of this approach remain uncertain. Criteria for the appropriate use of ad hoc intervention have not been established. Ad hoc intervention is reasonable for many, but not appropriate for all patients and should not be considered standard therapy. This document updates an earlier review of this topic and provides suggestions for the use of ad hoc intervention as a routine strategy. Catheter

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Patient Selection for Diagnostic Coronary Angiography and Hospital-Level Percutaneous Coronary Intervention Appropriateness

et al. 2014

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IMPORTANCE Diagnostic coronary angiography in asymptomatic patients may lead to inappropriate percutaneous coronary intervention (PCI) due to a diagnostic-therapeutic cascade. Understanding the association between patient selection for coronary angiography and PCI appropriateness may inform strategies to minimize inappropriate procedures.OBJECTIVE To determine if hospitals that frequently perform coronary angiography in asymptomatic patients, a clinical scenario in which the benefit of angiography is less clear, are more likely to perform inappropriate PCI.

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Cost Advantages of an Ad Hoc Angioplasty Strategy

Cited by 25 publications

References 15 publications

Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

Ad hoc vs. Non-ad hoc Percutaneous Coronary Intervention Strategies in Patients With Stable Coronary Artery Disease

SCAI statement on ad hoc versus the separate performance of diagnostic cardiac catheterization and coronary intervention

Patient Selection for Diagnostic Coronary Angiography and Hospital-Level Percutaneous Coronary Intervention Appropriateness

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