Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting

Clin Sci (Lond). 2008 Mar;114(6):423-30. doi: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Contrast Media
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / economics*
  • Coronary Disease / economics
  • Coronary Disease / physiopathology
  • Coronary Disease / surgery*
  • Female
  • Gadolinium
  • Health Resources / statistics & numerical data*
  • Health Services Research
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Length of Stay
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Preoperative Care / methods*
  • Prognosis
  • Prospective Studies
  • Scotland
  • Ventricular Function, Left

Substances

  • Contrast Media
  • Gadolinium