Author + information
Percutaneous coronary intervention (PCI) of calcified lesions (CL) often require additional resource utilization and lead to more frequent procedural complications. There is little data regarding the clinical outcomes and economic considerations for patients (pts) undergoing PCI of CL in current practice.
Using Medicare claims data, 235,381 PCI pts were identified between 10/2011 and 12/2012, of which 2,276 pts were coded as having CL (based on the specific ICD-9 code 414.4). 4:1 propensity matching was used to adjust for differences in baseline characteristics for pts with and without CL. Clinical outcomes and health care costs through 1 year of follow-up were compared between the groups.
The analytic cohort consisted of 11,380 pts (2,276 CL, 9,104 non-CL). During the index hospitalization, there were no differences in death or length of hospital stay; however, index hospitalization costs were higher for pts with CL ($25,238 vs. $22,668; p < 0.001). Over 1 year of follow-up, there were no differences in rates of death or myocardial infarction, but there was a significantly higher rate of repeat revascularization (13.6 vs. 10.7 procedures per 100 pts; p = 0.020) and higher revascularization costs ($3,551 vs. $2,577; p = 0.016) in the CL group. Overall, cumulative health-care related costs at 1 year were significantly higher in patients with CL ($54,579 vs. $49,833; p = 0.018).
Among Medicare pts undergoing PCI, treatment of CL was associated with increased rates of repeat revascularization and approximately $5000 higher medical costs over 1-year follow-up. These findings suggest that health-care related costs for pts undergoing PCI for CL are increased in both the short and long term and highlight the need for further studies to assess the clinical and economic value of specific treatment strategies for such pts.