Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes
Background Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described. Methods A single‐center CTO interventional program was initiated with requirements inc...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2013-07, Vol.82 (1), p.1-8 |
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| creator | Karmpaliotis, Dimitri Lembo, Nicholas Kalynych, Anna Carlson, Harold Lombardi, William L. Anderson, Chad N. Rinehart, Sarah Kirkland, Ben Shemwell, Kathie C. Kandzari, David E. |
| description | Background
Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described.
Methods
A single‐center CTO interventional program was initiated with requirements including: extensive didactic training, on‐site proctorship, routine determination of case appropriateness, adherence to procedural safety guidelines, and a 2‐operator/case approach. Clinical and angiographic characteristics, procedural outcomes, in‐hospital clinical events, and cost/resource utilization were examined.
Results
Among 145 patients, 160 consecutive CTO revascularization procedures were attempted between October 2009 and December 2010. Selected procedural and technical characteristics included: bilateral femoral access, 90.0%; planned retrograde guidewire placement, 37.5%; re‐entry catheter, 10.0%; reattempt, 10.6%; fluoroscopic time, 67.4 ± 45.5 min; contrast volume, 403 ± 215 mL. Average stent number and total stent length per CTO vessel were 2.6 ± 1.1 and 64.7 ± 30.7 mm, respectively. Overall CTO success rate was 85.6% (137/160). In‐hospital adverse outcomes included: death 0.6%; emergency bypass surgery, 0.6%; tamponade, 0.6%; myocardial infarction, 1.9%; transient nephropathy, 1.2%. Compared with patients undergoing non‐CTO PCI, procedural and total cost per patient were significantly higher among the CTO cohort despite overall similar contribution margins ($5,173 ± 12,052 versus $5,730 ± 8,958, P = 0.58).
Conclusions
Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development. © 2013 Wiley Periodicals, Inc. |
| doi_str_mv | 10.1002/ccd.24387 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1370637214</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3000900071</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3917-4662598dd59efd252177618df59204db128284ca9e64e034a876e4892d07586f3</originalsourceid><addsrcrecordid>eNp1kUtv1DAUhSMEog9Y8AeQJTZUalrbie2EHZrSghiBxFtsLNe56bh14uDHQPlV_EQ8zbQLJFY-tr5zdK9PUTwh-IhgTI-17o5oXTXiXrFLGKWloPzb_a0mbc13ir0QLjHGLaftw2KHVkxwRtvd4s8JrMG6aYAxItcjhVbmYlWunU0DHKIh2WgmC6WbwKvoPJq8u_BqQP1Gg9cpqhFcCkivvBuNRtFFZZF2-ab8NXJa2xSMG5GHtQo6WeXNbxXzy4tNmIYueWUPkbYm2zdKjV32h1imaOyWRS5F7QYIj4oHvbIBHm_P_eLz6atPi9fl8v3Zm8XLZamrloiy5pyytuk61kLfUUaJEJw0Xc9aiuvunNCGNrVWLfAacFWrRnCom5Z2WLCG99V-8XzOzTP-SBCiHEzQYO28riSVwLwSlNQZffYPeumSH_N0NxSuOGM8Uwczpb0LwUMvJ2-G_EWSYLmpUeYa5U2NmX26TUznA3R35G1vGTiegZ_GwvX_k-RicXIbWc4OEyL8unMofyW5qASTX9-dSf72y8fl6fdGfqj-AqUtuYQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1370036556</pqid></control><display><type>article</type><title>Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Karmpaliotis, Dimitri ; Lembo, Nicholas ; Kalynych, Anna ; Carlson, Harold ; Lombardi, William L. ; Anderson, Chad N. ; Rinehart, Sarah ; Kirkland, Ben ; Shemwell, Kathie C. ; Kandzari, David E.</creator><creatorcontrib>Karmpaliotis, Dimitri ; Lembo, Nicholas ; Kalynych, Anna ; Carlson, Harold ; Lombardi, William L. ; Anderson, Chad N. ; Rinehart, Sarah ; Kirkland, Ben ; Shemwell, Kathie C. ; Kandzari, David E.</creatorcontrib><description>Background
Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described.
Methods
A single‐center CTO interventional program was initiated with requirements including: extensive didactic training, on‐site proctorship, routine determination of case appropriateness, adherence to procedural safety guidelines, and a 2‐operator/case approach. Clinical and angiographic characteristics, procedural outcomes, in‐hospital clinical events, and cost/resource utilization were examined.
Results
Among 145 patients, 160 consecutive CTO revascularization procedures were attempted between October 2009 and December 2010. Selected procedural and technical characteristics included: bilateral femoral access, 90.0%; planned retrograde guidewire placement, 37.5%; re‐entry catheter, 10.0%; reattempt, 10.6%; fluoroscopic time, 67.4 ± 45.5 min; contrast volume, 403 ± 215 mL. Average stent number and total stent length per CTO vessel were 2.6 ± 1.1 and 64.7 ± 30.7 mm, respectively. Overall CTO success rate was 85.6% (137/160). In‐hospital adverse outcomes included: death 0.6%; emergency bypass surgery, 0.6%; tamponade, 0.6%; myocardial infarction, 1.9%; transient nephropathy, 1.2%. Compared with patients undergoing non‐CTO PCI, procedural and total cost per patient were significantly higher among the CTO cohort despite overall similar contribution margins ($5,173 ± 12,052 versus $5,730 ± 8,958, P = 0.58).
Conclusions
Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development. © 2013 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.24387</identifier><identifier>PMID: 23576529</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Aged ; angioplasty ; Chronic Disease ; chronic total occlusion ; Coronary Angiography ; Coronary Occlusion - diagnosis ; Coronary Occlusion - economics ; Coronary Occlusion - therapy ; cost ; Cost-Benefit Analysis ; Female ; Guideline Adherence ; Hospital Costs ; Hospitals, High-Volume - standards ; Humans ; Male ; Middle Aged ; percutaneous coronary intervention ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - economics ; Percutaneous Coronary Intervention - instrumentation ; Percutaneous Coronary Intervention - standards ; Percutaneous Coronary Intervention - utilization ; Practice Guidelines as Topic ; Predictive Value of Tests ; Program Development ; Quality Indicators, Health Care ; resource utilization ; Retrospective Studies ; Stents ; Treatment Outcome</subject><ispartof>Catheterization and cardiovascular interventions, 2013-07, Vol.82 (1), p.1-8</ispartof><rights>Copyright © 2013 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3917-4662598dd59efd252177618df59204db128284ca9e64e034a876e4892d07586f3</citedby><cites>FETCH-LOGICAL-c3917-4662598dd59efd252177618df59204db128284ca9e64e034a876e4892d07586f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.24387$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.24387$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23576529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Lembo, Nicholas</creatorcontrib><creatorcontrib>Kalynych, Anna</creatorcontrib><creatorcontrib>Carlson, Harold</creatorcontrib><creatorcontrib>Lombardi, William L.</creatorcontrib><creatorcontrib>Anderson, Chad N.</creatorcontrib><creatorcontrib>Rinehart, Sarah</creatorcontrib><creatorcontrib>Kirkland, Ben</creatorcontrib><creatorcontrib>Shemwell, Kathie C.</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><title>Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Background
Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described.
Methods
A single‐center CTO interventional program was initiated with requirements including: extensive didactic training, on‐site proctorship, routine determination of case appropriateness, adherence to procedural safety guidelines, and a 2‐operator/case approach. Clinical and angiographic characteristics, procedural outcomes, in‐hospital clinical events, and cost/resource utilization were examined.
Results
Among 145 patients, 160 consecutive CTO revascularization procedures were attempted between October 2009 and December 2010. Selected procedural and technical characteristics included: bilateral femoral access, 90.0%; planned retrograde guidewire placement, 37.5%; re‐entry catheter, 10.0%; reattempt, 10.6%; fluoroscopic time, 67.4 ± 45.5 min; contrast volume, 403 ± 215 mL. Average stent number and total stent length per CTO vessel were 2.6 ± 1.1 and 64.7 ± 30.7 mm, respectively. Overall CTO success rate was 85.6% (137/160). In‐hospital adverse outcomes included: death 0.6%; emergency bypass surgery, 0.6%; tamponade, 0.6%; myocardial infarction, 1.9%; transient nephropathy, 1.2%. Compared with patients undergoing non‐CTO PCI, procedural and total cost per patient were significantly higher among the CTO cohort despite overall similar contribution margins ($5,173 ± 12,052 versus $5,730 ± 8,958, P = 0.58).
Conclusions
Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development. © 2013 Wiley Periodicals, Inc.</description><subject>Aged</subject><subject>angioplasty</subject><subject>Chronic Disease</subject><subject>chronic total occlusion</subject><subject>Coronary Angiography</subject><subject>Coronary Occlusion - diagnosis</subject><subject>Coronary Occlusion - economics</subject><subject>Coronary Occlusion - therapy</subject><subject>cost</subject><subject>Cost-Benefit Analysis</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Hospital Costs</subject><subject>Hospitals, High-Volume - standards</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>percutaneous coronary intervention</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - economics</subject><subject>Percutaneous Coronary Intervention - instrumentation</subject><subject>Percutaneous Coronary Intervention - standards</subject><subject>Percutaneous Coronary Intervention - utilization</subject><subject>Practice Guidelines as Topic</subject><subject>Predictive Value of Tests</subject><subject>Program Development</subject><subject>Quality Indicators, Health Care</subject><subject>resource utilization</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Treatment Outcome</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtv1DAUhSMEog9Y8AeQJTZUalrbie2EHZrSghiBxFtsLNe56bh14uDHQPlV_EQ8zbQLJFY-tr5zdK9PUTwh-IhgTI-17o5oXTXiXrFLGKWloPzb_a0mbc13ir0QLjHGLaftw2KHVkxwRtvd4s8JrMG6aYAxItcjhVbmYlWunU0DHKIh2WgmC6WbwKvoPJq8u_BqQP1Gg9cpqhFcCkivvBuNRtFFZZF2-ab8NXJa2xSMG5GHtQo6WeXNbxXzy4tNmIYueWUPkbYm2zdKjV32h1imaOyWRS5F7QYIj4oHvbIBHm_P_eLz6atPi9fl8v3Zm8XLZamrloiy5pyytuk61kLfUUaJEJw0Xc9aiuvunNCGNrVWLfAacFWrRnCom5Z2WLCG99V-8XzOzTP-SBCiHEzQYO28riSVwLwSlNQZffYPeumSH_N0NxSuOGM8Uwczpb0LwUMvJ2-G_EWSYLmpUeYa5U2NmX26TUznA3R35G1vGTiegZ_GwvX_k-RicXIbWc4OEyL8unMofyW5qASTX9-dSf72y8fl6fdGfqj-AqUtuYQ</recordid><startdate>20130701</startdate><enddate>20130701</enddate><creator>Karmpaliotis, Dimitri</creator><creator>Lembo, Nicholas</creator><creator>Kalynych, Anna</creator><creator>Carlson, Harold</creator><creator>Lombardi, William L.</creator><creator>Anderson, Chad N.</creator><creator>Rinehart, Sarah</creator><creator>Kirkland, Ben</creator><creator>Shemwell, Kathie C.</creator><creator>Kandzari, David E.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20130701</creationdate><title>Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes</title><author>Karmpaliotis, Dimitri ; Lembo, Nicholas ; Kalynych, Anna ; Carlson, Harold ; Lombardi, William L. ; Anderson, Chad N. ; Rinehart, Sarah ; Kirkland, Ben ; Shemwell, Kathie C. ; Kandzari, David E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3917-4662598dd59efd252177618df59204db128284ca9e64e034a876e4892d07586f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>angioplasty</topic><topic>Chronic Disease</topic><topic>chronic total occlusion</topic><topic>Coronary Angiography</topic><topic>Coronary Occlusion - diagnosis</topic><topic>Coronary Occlusion - economics</topic><topic>Coronary Occlusion - therapy</topic><topic>cost</topic><topic>Cost-Benefit Analysis</topic><topic>Female</topic><topic>Guideline Adherence</topic><topic>Hospital Costs</topic><topic>Hospitals, High-Volume - standards</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>percutaneous coronary intervention</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Percutaneous Coronary Intervention - economics</topic><topic>Percutaneous Coronary Intervention - instrumentation</topic><topic>Percutaneous Coronary Intervention - standards</topic><topic>Percutaneous Coronary Intervention - utilization</topic><topic>Practice Guidelines as Topic</topic><topic>Predictive Value of Tests</topic><topic>Program Development</topic><topic>Quality Indicators, Health Care</topic><topic>resource utilization</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karmpaliotis, Dimitri</creatorcontrib><creatorcontrib>Lembo, Nicholas</creatorcontrib><creatorcontrib>Kalynych, Anna</creatorcontrib><creatorcontrib>Carlson, Harold</creatorcontrib><creatorcontrib>Lombardi, William L.</creatorcontrib><creatorcontrib>Anderson, Chad N.</creatorcontrib><creatorcontrib>Rinehart, Sarah</creatorcontrib><creatorcontrib>Kirkland, Ben</creatorcontrib><creatorcontrib>Shemwell, Kathie C.</creatorcontrib><creatorcontrib>Kandzari, David E.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karmpaliotis, Dimitri</au><au>Lembo, Nicholas</au><au>Kalynych, Anna</au><au>Carlson, Harold</au><au>Lombardi, William L.</au><au>Anderson, Chad N.</au><au>Rinehart, Sarah</au><au>Kirkland, Ben</au><au>Shemwell, Kathie C.</au><au>Kandzari, David E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Cathet. Cardiovasc. Intervent</addtitle><date>2013-07-01</date><risdate>2013</risdate><volume>82</volume><issue>1</issue><spage>1</spage><epage>8</epage><pages>1-8</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Background
Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described.
Methods
A single‐center CTO interventional program was initiated with requirements including: extensive didactic training, on‐site proctorship, routine determination of case appropriateness, adherence to procedural safety guidelines, and a 2‐operator/case approach. Clinical and angiographic characteristics, procedural outcomes, in‐hospital clinical events, and cost/resource utilization were examined.
Results
Among 145 patients, 160 consecutive CTO revascularization procedures were attempted between October 2009 and December 2010. Selected procedural and technical characteristics included: bilateral femoral access, 90.0%; planned retrograde guidewire placement, 37.5%; re‐entry catheter, 10.0%; reattempt, 10.6%; fluoroscopic time, 67.4 ± 45.5 min; contrast volume, 403 ± 215 mL. Average stent number and total stent length per CTO vessel were 2.6 ± 1.1 and 64.7 ± 30.7 mm, respectively. Overall CTO success rate was 85.6% (137/160). In‐hospital adverse outcomes included: death 0.6%; emergency bypass surgery, 0.6%; tamponade, 0.6%; myocardial infarction, 1.9%; transient nephropathy, 1.2%. Compared with patients undergoing non‐CTO PCI, procedural and total cost per patient were significantly higher among the CTO cohort despite overall similar contribution margins ($5,173 ± 12,052 versus $5,730 ± 8,958, P = 0.58).
Conclusions
Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development. © 2013 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>23576529</pmid><doi>10.1002/ccd.24387</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged angioplasty Chronic Disease chronic total occlusion Coronary Angiography Coronary Occlusion - diagnosis Coronary Occlusion - economics Coronary Occlusion - therapy cost Cost-Benefit Analysis Female Guideline Adherence Hospital Costs Hospitals, High-Volume - standards Humans Male Middle Aged percutaneous coronary intervention Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - economics Percutaneous Coronary Intervention - instrumentation Percutaneous Coronary Intervention - standards Percutaneous Coronary Intervention - utilization Practice Guidelines as Topic Predictive Value of Tests Program Development Quality Indicators, Health Care resource utilization Retrospective Studies Stents Treatment Outcome |
| title | Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes |
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