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.
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March 2008
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Research Article|
February 12 2008
Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting
Colin Berry;
Colin Berry
1
*British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, U.K.
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
Correspondence: Dr Colin Berry, present address: Cardiovascular Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-1538, U.S.A. (email [email protected]).
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Lukas U. Zimmerli;
Lukas U. Zimmerli
1
*British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, U.K.
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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Tracey Steedman;
Tracey Steedman
*British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, U.K.
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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John E. Foster;
John E. Foster
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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Henry J. Dargie;
Henry J. Dargie
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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Geoffrey A. Berg;
Geoffrey A. Berg
‡Department of Cardiac Surgery, Western Infirmary, Glasgow, Scotland, U.K.
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Anna F. Dominiczak;
Anna F. Dominiczak
*British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, U.K.
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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Christian Delles
Christian Delles
*British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, U.K.
†Glasgow Cardiac Magnetic Resonance Unit, Western Infirmary, Glasgow, Scotland, U.K.
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Publisher: Portland Press Ltd
Received:
September 24 2007
Revision Received:
November 01 2007
Accepted:
November 14 2007
Accepted Manuscript online:
November 14 2007
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2008 Biochemical Society
2008
Clin Sci (Lond) (2008) 114 (6): 423–430.
Article history
Received:
September 24 2007
Revision Received:
November 01 2007
Accepted:
November 14 2007
Accepted Manuscript online:
November 14 2007
Citation
Colin Berry, Lukas U. Zimmerli, Tracey Steedman, John E. Foster, Henry J. Dargie, Geoffrey A. Berg, Anna F. Dominiczak, Christian Delles; Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting. Clin Sci (Lond) 1 March 2008; 114 (6): 423–430. doi: https://doi.org/10.1042/CS20070337
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