Abstract:
OBJECTIVES:This study was designed to evaluate more closely the true in-hospital costs of elective revascularization by directional coronary atherectomy and intracoronary stenting and to compare these costs with those of the traditional revascularization alternatives (i.e., conventional balloon angioplasty and coronary artery bypass surgery). BACKGROUND:Previous studies have suggested that total hospital charges for directional coronary atherectomy or intracoronary stenting are significantly higher than those for conventional angioplasty. However, hospital charges do not necessarily reflect true economic costs, and their use may provide misleading data with regard to cost-effectiveness. METHODS:We analyzed in-hospital charges from the itemized hospital accounts of 300 patients undergoing elective angioplasty, directional atherectomy, Palmaz-Schatz coronary stenting or bypass surgery between January 1, 1990 and December 31, 1991. Costs were then derived by adjusting itemized patient accounts for department-specific cost/charge ratios. Catheterization laboratory costs were based on actual resource consumption, and daily room costs were adjusted for the intensity of nursing services provided. RESULTS:Length of hospital stay was similar for atherectomy (2.3 +/- 1.5 days) and conventional angioplasty (2.6 +/- 1.7 days) but significantly longer for stenting (5.5 +/- 2.6 days, p < 0.05). Total costs were also significantly higher for coronary stenting ($7,878 +/- $3,270, median $6,699, p < 0.05) than for angioplasty ($5,396 +/- $2,829, median $4,753) or atherectomy ($5,726 +/- $2,716, median $4,986). However, length of stay, resource consumption (laboratory and radiologic testing, drugs, blood products, for example) and total costs for bypass surgery were still greater than for any of the percutaneous interventional procedures. CONCLUSIONS:In contrast to previous studies utilizing only hospital charges, the in-hospital costs of angioplasty and directional coronary atherectomy were similar. Although the cost of coronary stenting was approximately $2,500 higher than that of conventional angioplasty, the magnitude of this difference was smaller than the $6,300 increment previously suggested on the basis of analysis of hospital charges. These findings reflect the inherent discrepancies between cost-based and charge-based methodologies and may have important implications for future studies evaluating the relative cost-effectiveness of newer coronary interventions.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Cohen DJ,Breall JA,Ho KK,Weintraub RM,Kuntz RE,Weinstein MC,Baim DSdoi
10.1016/0735-1097(93)90415-wsubject
Has Abstractpub_date
1993-10-01 00:00:00pages
1052-9issue
4eissn
0735-1097issn
1558-3597pii
0735-1097(93)90415-Wjournal_volume
22pub_type
杂志文章abstract::Coronary angioplasty as it is now performed has several limitations, including abrupt early arterial closure and delayed restenosis. To obviate these problems and to enhance the safety of the technique, several intracoronary stenting devices have been developed and are under investigation. This report reviews the scie...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/0735-1097(89)90323-9
更新日期:1989-05-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate whether calcium deposition in the coronary arteries is related to atherosclerotic plaque burden and narrowing of the arterial lumen. BACKGROUND:Many studies have recently documented the feasibility of electron beam computed tomography to detect and quantify coronary arter...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00443-9
更新日期:1998-01-01 00:00:00
abstract:OBJECTIVES:We sought to test the hypothesis that activation of the serotonergic system in patients with vasovagal syndrome during the head-up tilt test provokes syncope. BACKGROUND:Central serotonergic activation participates in the pathogenesis of neurocardiogenic syncope. Drugs increasing serotonin (5-HT) in the cen...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00719-1
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:A high percentage of biventricular pacing is required for optimal outcome in patients treated with cardiac resynchronization therapy (CRT), but the influence of ectopic beats on the success of biventricular pacing has not been well established. OBJECTIVES:This study sought to determine if increased ectopic ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2014.06.1177
更新日期:2014-09-09 00:00:00
abstract:OBJECTIVES:The hypothesis of this study was that evaluation of myocardial flow and metabolism using nitrogen-13 (N-13) ammonia kinetic modeling with dynamic positron emission tomographic (PET) imaging could identify regions of myocardial scar and viable myocardium as defined by fluorine-18 fluorodeoxyglucose (F-18 FDG)...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(96)00561-x
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVES:The aim of this retrospective study was to determine the predictors of diffuse in-stent restenosis (ISR) among the lesions causing the first ISR by intravascular ultrasound (IVUS) studies. BACKGROUND:Although some predictors of diffuse ISR have been reported, parameters on IVUS relating to diffuse ISR are n...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.05.009
更新日期:2003-11-19 00:00:00
abstract:OBJECTIVES:We investigated the acute effect of orally administered high-dose folic acid on coronary dilator function in humans. BACKGROUND:Folic acid and its active metabolite, 5-methyltetrahydrofolate, increase endothelium-dependent vasodilation in human peripheral circulation. However, the acute effect on coronary c...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jacc.2005.02.038
更新日期:2005-05-17 00:00:00
abstract:OBJECTIVES:The purpose of this study was to assess trends in endothelial coverage and recovery among leading polymer-based drug-eluting stents (DES). BACKGROUND:Autopsy studies of human U.S. Food and Drug Administration (FDA)-approved DES implanted coronary arteries suggest that complications of late stent thrombosis ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.04.030
更新日期:2008-07-29 00:00:00
abstract:OBJECTIVES:The aim of this study was to characterize fully in vivo aortic compliance over a wide range of passive distending pressures, and to study pharmacologically induced alterations in compliance using an intravascular ultrasound-based technique in the canine model of heart failure. BACKGROUND:Altered aortic comp...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00530-0
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the rate of recognition of atrial fibrillation (AF), use of warfarin and prevalence of cerebrovascular accident (CVA) in paced versus unpaced patients during admission to a tertiary care teaching hospital. BACKGROUND:The presence of AF underlying a continuously pace...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00794-4
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the effects of sodium channel blockade on anisotropic excitation propagation in the intact canine left ventricle. BACKGROUND:Anisotropic ventricular conduction- electric conductivity dependent on the myocardial fiber direction-is one of the important mechanisms of ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)82543-0
更新日期:1997-06-01 00:00:00
abstract::Directional coronary atherectomy, a new transluminal procedure for treatment of obstructive lesions in coronary arteries by excision and removal of tissue, was performed on 447 lesions in 382 procedures. Successful outcome, defined as a reduction of stenosis by greater than or equal to 20% with a less than 50% residua...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90840-6
更新日期:1991-04-01 00:00:00
abstract::To be of clinical value in the treatment of heart failure, a drug must permit patients either to feel better or to live longer, or both. Yet, because the assessment of both quality and quantity of life is difficult, many investigators have proposed using alternate measures (namely, surrogate end points) that may indic...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90487-l
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVES:We investigated the effect of inhaled nitric oxide and infused acetylcholine in patients with pulmonary hypertension undergoing cardiac catheterization before cardiopulmonary transplantation. BACKGROUND:The fate of patients under consideration for transplantation of the heart or lungs, or both, is influence...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00048-9
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVES:This study evaluates the hemodynamic, bioenergetic and cytoprotective effects of urocortin (Ucn) in the isolated rat heart exposed to ischemia (I)/reperfusion (R). BACKGROUND:We have previously demonstrated that administration of exogenous Ucn reduces infarct size in ischemic-reperfused rat hearts. METHODS...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)01930-7
更新日期:2002-07-03 00:00:00
abstract::To determine whether long-term blood pressure levels correlate with left ventricular mass, echocardiographic measurements were performed in 152 men and 299 women who were participants in the Framingham Heart Study. All subjects were free of obesity and cardiovascular and pulmonary disease, were not taking antihyperten...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90549-o
更新日期:1991-11-01 00:00:00
abstract::The relation between perfusion of the infarct-related artery and changes in left ventricular volume and function during the month after a first myocardial infarction was examined in 40 patients who did not receive thrombolytic therapy. Infarct artery perfusion was documented at predischarge coronary angiography, and l...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(87)80298-x
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVES:We report our initial experience with percutaneous pulmonary valve replacement in animals with large pulmonary trunks, using a modified percutaneous approach. BACKGROUND:Percutaneous pulmonary valve replacement has recently been introduced, and early clinical experience has been reported. This technique is ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.10.037
更新日期:2004-03-17 00:00:00
abstract:BACKGROUND:Hypertrophic cardiomyopathy (HCM) is an uncommon but important cause of sudden cardiac death. OBJECTIVES:This study sought to develop an artificial intelligence approach for the detection of HCM based on 12-lead electrocardiography (ECG). METHODS:A convolutional neural network (CNN) was trained and validat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2019.12.030
更新日期:2020-02-25 00:00:00
abstract::Nonionic contrast media are suggested to cause increased thromboembolism (in vivo), platelet aggregation and procoagulant effect (in vitro) as compared with ionic contrast media. To study these effects in vivo, 30 consecutive patients undergoing routine angiography were prospectively randomized to three groups of 10 p...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0735-1097(91)90643-n
更新日期:1991-06-01 00:00:00
abstract:OBJECTIVES:This study examined the influence of left ventricular hypertrophy on the accuracy of exercise electrocardiography and echocardiography for detection of coronary artery disease. BACKGROUND:Electrocardiographic repolarization abnormalities caused by left ventricular hypertrophy compromise the diagnostic accur...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/0735-1097(96)81472-0
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the effect of amino-terminal pro-brain natriuretic peptide (N-BNP) on the diagnostic accuracy of heart failure (HF) in primary care. BACKGROUND:The accurate diagnosis of patients with suspected HF presenting in primary care is difficult. Amino-terminal pro-brain na...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jacc.2003.05.011
更新日期:2003-11-19 00:00:00
abstract:OBJECTIVES:This study was designed to establish the direct vascular effects of apelin in vivo in man. BACKGROUND:Apelin is the endogenous ligand for the previously orphaned G-protein-coupled receptor, APJ. This novel pathway is widely expressed in the cardiovascular system and is emerging as an important mediator of c...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.06.013
更新日期:2008-09-09 00:00:00
abstract::The prevalence of an abnormal signal-averaged electrocardiogram (ECG) and ventricular arrhythmias on 24 h ambulatory electrocardiography was evaluated in 118 patients 13 +/- 2 days after acute myocardial infarction. Group 1 (46 patients) underwent intravenous thrombolysis within 6 h of the onset of symptoms, whereas G...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80012-9
更新日期:1990-05-01 00:00:00
abstract:BACKGROUND:Coronary computed tomography angiography (CTA) is increasingly being used for evaluation of coronary artery disease (CAD). As a result of the widely reported potential of carcinogenic risk from x-ray based examinations, many strategies have been developed for dose reduction with CTA. OBJECTIVES:The purpose ...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jacc.2014.04.079
更新日期:2014-08-26 00:00:00
abstract:OBJECTIVES:We attempted to assess the efficacy of combined cardiac resynchronization therapy-implantable cardioverter-defibrillator (CRT-ICD) in heart failure patients with and without ventricular arrhythmias. BACKGROUND:Because CRT and ICDs both lower all-cause mortality in patients with advanced heart failure, combi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2006.04.072
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to clarify the impact of sex-related differences in transcatheter aortic valve implantation (TAVI) for high-risk patients with severe aortic stenosis. BACKGROUND:Although TAVI is becoming a mature technique, the impact of sex differences remains unclear. METHODS:The TAVI patie...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2011.10.877
更新日期:2012-02-07 00:00:00
abstract:OBJECTIVES:Our purpose was to quantify the frequency and distribution of suspected vulnerable lesions, defined as thin-capped fibroatheroma (TCFA) and ruptured plaque, in human coronary artery autopsy specimens. BACKGROUND:Most acute coronary events and sudden death are believed to arise from rupture of a TCFA followe...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.04.086
更新日期:2007-09-04 00:00:00
abstract::This is a report of successful dilation of stenosis of the common trunk in a case of total anomalous pulmonary vein return into the left superior vena cava in a 3 month old infant. Percutaneous angioplasty was performed with a 6 mm diameter balloon catheter. Right ventricular systolic pressure decreased from 96 to 60 ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80501-5
更新日期:1985-10-01 00:00:00
abstract::The prevalence of abnormalities of lipoprotein cholesterol and apolipoproteins A-I and B and lipoprotein (a) [Lp(a)] was determined in 321 men (mean age 50 +/- 7 years) with angiographically documented coronary artery disease and compared with that in 901 control subjects from the Framingham Offspring Study (mean age ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90520-w
更新日期:1992-03-15 00:00:00