Author + information
- Received May 10, 2018
- Revision received September 27, 2018
- Accepted October 9, 2018
- Published online February 18, 2019.
- Adam C. Salisbury, MD, MSca,b,∗ (, )
- Dimitri Karmpaliotis, MDc,
- J. Aaron Grantham, MDa,b,
- James Sapontis, MDd,
- Qingrui Meng, MSa,
- Elizabeth A. Magnuson, ScDa,b,
- Hemal Gada, MDe,
- William Lombardi, MDf,
- Jeffrey Moses, MDc,
- Haiyan Li, MSa,
- Suzanne V. Arnold, MD, MHAa,b,
- Suzanne J. Baron, MD, MSca,b,
- John A. Spertus, MD, MPHa,b and
- David J. Cohen, MD, MSca,b
- aSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- bUniversity of Missouri–Kansas City, Kansas City, Missouri
- cColumbia University Medical Center and New York Presbyterian Hospital, New York, New York
- dMonash Heart, Melbourne, Australia
- ePinnacleHealth Cardiovascular Institute, Wormleysburg, Pennsylvania
- fUniversity of Washington School of Medicine, Seattle, Washington
- ↵∗Address for correspondence:
Dr. Adam C. Salisbury, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, CV Research, 9th Floor, Kansas City, Missouri 64111.
Objectives The aim of this study was to describe the costs of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and the association of complications during CTO PCI with costs and length of stay (LOS).
Background CTO PCI generally requires more procedural resources and carries higher risk for complications than PCI of non-CTO vessels. The costs of CTO PCI using the hybrid approach have not been described, and no studies have examined the impact of complications on in-hospital costs and LOS in this population.
Methods Costs were calculated for 964 patients in the 12-center OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry using prospectively collected resource utilization and billing data. Multivariate models were developed to estimate the incremental costs and LOS associated with complications. Attributable costs and LOS were calculated by multiplying the independent cost of each event by its frequency in the population.
Results Mean costs for the index hospitalization were $17,048 ± 9,904; 14.5% of patients experienced at least 1 complication. Patients with complications had higher mean hospital costs (by $8,603) and LOS (by 1.5 days) than patients without complications. Seven complications were independently associated with increased costs and 6 with LOS; clinically significant perforation and myocardial infarction had the greatest attributable cost per patient. Overall, complications accounted for $911 per patient in hospital costs (5.3% of the total costs) and 0.2 days of additional LOS.
Conclusions Complications have a significant impact on both LOS and in-hospital costs for patients undergoing CTO PCI. Methods to identify high-risk patients and develop strategies to prevent complications may reduce CTO PCI costs.
The OPEN-CTO study was funded by an unrestricted grant from Boston Scientific. Dr. Salisbury has received institutional research grants from Boston Scientific and Gilead. Dr. Grantham has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Asahi Intecc; institutional research grant support from Boston Scientific; and institutional educational grant support from Abbott Vascular, Vascular Solutions, Boston Scientific, and Asahi Intecc. Dr. Grantham is a part-time employee of Corindus Vascular Robotics. Dr. Sapontis has received speaking fees and honoraria from Boston Scientific. Dr. Lombardi has received speaking fees and honoraria from Boston Scientific, Abbott Vascular, and Abiomed; and consultancy fees from Vascular Solutions, Abbott Vascular, Boston Scientific, Abiomed, and Roxwood Medical. Dr. Lombardi has equity in Roxwood Medical and Bridgepoint Medical; and his wife is an employee of Spectranetics. Dr. Karmpaliotis has received speaking fees, honoraria, and consulting fees from Abbott Vascular, Boston Scientific, and Medtronic. Dr. Baron has received research grant support from Boston Scientific. Dr. Spertus has received research grants from Lilly, Novartis, and Abbott Vascular; has served as a consultant for Novartis, Cytokinetics, Bayer, and United Healthcare; owns the copyright to the SAQ; and has an equity interest in Health Outcomes Sciences. Dr. Cohen has received institutional research grant support from Boston Scientific, Abbott Vascular, and Medtronic; and consulting fees from Medtronic and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2018.
- Revision received September 27, 2018.
- Accepted October 9, 2018.
- 2019 American College of Cardiology Foundation
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