Objective:
To assess the economic impact of MACE during cardiac catheterization procedures in both high and low risk patients and to apply literature estimates of MACE rates the iso-osmolar iodinated contrast media iodixanol versus low-osmolar contrast media (LOCM).
Methods:
We performed a retrospective analysis using the Premier Perspective™ database, which contains patient-level data including primary and secondary diagnosis and procedure codes. Inpatient adults without prior hemodialysis who underwent invasive cardiac catheterization procedures with contrast media during 2007-2008 were studied. MACE was defined as acute MI, ischemic heart disease, or angina. Resource utilization, re-admittance rate, length of stay (LOS), and cost were collected. High-risk patients were defined as have an AMI or angina as the admitting diagnosis. Aggregate MACE outcomes were then applied to MACE rates from multi-center studies found in the literature comparing iodixanol to LOCM.
Results:
Among 521,437 patients in the Premier Perspective™ undergoing CCP, 13,149 (2.52%) experienced a MACE. Of those experiencing MACE, high-risk patients had longer LOS, 4.2 vs. 3.3 days, p <0.0001, longer ICU LOS. 2.6 vs. 2.3 days, p= 0.0028, greater total costs, $15,020 vs. $12,413, p <0.0001, and a greater frequency of MACE readmission due to re-catheterization, 58.66% vs. 50.68%, p= <0.0001. For readmissions within 30 days post-discharge, LOS and cost remained statistically significant for high-risk patients, but ICU LOS was not significantly different. In applying literature-based MACE rates, isosmolar iodixanol versus LOCM iopamidol potentially saves on average $600 per patient in inpatient MACE-related costs but no difference for 30 days post-discharge MACE. Additionally, iodixanol may save up to $616 on average per patient vs. Ioxaglate in high-risk inpatient MACE-related costs, but no difference in non high-risk patients.
Conclusions:
MACE is a complication in CCP with substantial resource utilization, cost, and mortality associated with it. The iso-osmolar contrast agent iodixanol may reduce the rate of MACE in certain instances and therefore reduce the MACE-related cost and resource utilization associated with cardiac catheterization procedures.
A MULTIDISCIPLINARY, MULTIMODALITY, BUT MINIMALIST (3M) APPROACH TO TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENT FACILITATES SAFE NEXT DAY DISCHARGE HOME IN HIGH RISK PATIENTS: 1 YEAR FOLLOW UP