PCI or CABG: which patients and at what cost?

Gershlick, Tony; Thomas, Martyn

doi:10.1136/hrt.2007.124750

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Previous studies have examined the relationship between the resource use associated with CABG procedures, patient characteristics, 9–11 clinical techniques or revascularisation procedures, 12–14 and postoperative morbidity or complications. 15 16 While OPCAB accounted for 60% of all CABG procedures in 2009 and is a major surgical procedure in Japan, 17 few studies have been conducted to investigate the effect of both preoperative patient and hospital factors on OPCAB cost and LOS using multilevel analysis.…”

Section: Introductionmentioning

confidence: 99%

Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

Shinjo

Fushimi

2015

BMJ Open

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ObjectiveTo determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB).DesignObservational retrospective study.SettingsData from the Japanese Administrative Database.ParticipantsPatients who underwent isolated, elective OPCAB between April 2011 and March 2012.Primary outcome measuresThe primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors.ResultsWe identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40 665 ±7774, and the mean LOS was 23.4±8.2 days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (−6.6%; p=0.024) as well as a short LOS (−17.6%, p<0.001).ConclusionsThe hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS.

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Section: Introductionmentioning

confidence: 99%

Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

Shinjo

Fushimi

2015

BMJ Open

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“…These services are available in many UK acute sector hospitals; indeed developments in the treatment of cardiac disease in the past 10 years have shifted care towards PCI so that in the UK in 2005, 73,000 PCIs were performed (Gershlick and Thomas, 2007, although many of these were elective procedures and not in acute care). Zijlstra et al (1997), states that the main risk of using thrombolysis instead of primary coronary angioplasty in the treatment of low risk patients with an acute myocardial infarction is re-infarction.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis administration by nurses: An evolving UK evidence base?

Sloman

Williamson

2009

International Emergency Nursing

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“…The extent of collateral flow is not always adequately estimated by coronary angiography, because there is a capacity for further dilatation in response to neurohumoral mediators 6. There are controversial opinions and results in the literature concerning the proper treatment of severe but asymptomatic coronary artery disease 7. Conversely, recanalization of chronic total occlusions, especially when the left anterior descending artery is involved, with percutaneous coronary intervention can reduce mortality and the need for bypass surgery,8 and even improve symptoms and prognosis 9.…”

Section: Discussionmentioning

confidence: 99%

“… 6 There are controversial opinions and results in the literature concerning the proper treatment of severe but asymptomatic coronary artery disease. 7 Conversely, recanalization of chronic total occlusions, especially when the left anterior descending artery is involved, with percutaneous coronary intervention can reduce mortality and the need for bypass surgery, 8 and even improve symptoms and prognosis. 9 If coronary artery bypass grafting is selected as the initial therapeutic strategy, optimal visualization of the target vessel in its entire length through feeding collaterals is mandatory for deciding the feasibility of the former, but the surgeon should also construct a plan for the site of graft implantation, and the potential need for downstream endarterectomy.…”

Section: Discussionmentioning

confidence: 99%

Angiographic estimation of atherosclerotic disease burden in a coronary artery fed by collaterals: a potential pitfall in decision for revascularization

Tsigkas

Mylona²,

Davlouros³

et al. 2011

VHRM

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Despite the remarkable advances in revascularization strategies made during the last decade, a significant proportion of patients are excluded from either percutaneous coronary intervention or coronary artery bypass grafting because of unsuitable coronary anatomy. Diffuse severe coronary artery disease, small vessel caliber, chronic total occlusions, or extremely calcified vessels are frequent reasons for deferring revascularization with either percutaneous coronary intervention or coronary artery bypass grafting. We present a case concerning a middle-aged asymptomatic patient who was treated successfully with percutaneous coronary intervention due to a chronic total occlusion lesion of the left anterior descending artery. Coronary angiography is an inadequate method for the estimation of the burden of atherosclerotic disease in an artery fed by collaterals. Assessment of any residual antegrade flow, and ipsilateral and contralateral collateral filling of the segments distal to the occlusion with invasive or noninvasive techniques, could affect the appropriate decision-making by physicians.

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PCI or CABG: which patients and at what cost?

Cited by 7 publications

References 21 publications

Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis

Thrombolysis administration by nurses: An evolving UK evidence base?

Angiographic estimation of atherosclerotic disease burden in a coronary artery fed by collaterals: a potential pitfall in decision for revascularization

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