Is a chronic total occlusion worth rechanneling? This question can often be found in different studies, all of them with clinical endpoints. This study (soon to be published in J Am Coll Cardiol Intv.) analyzes another aspect: costs, not only derived from materials used for a successful procedure, but also from materials and hospital stay in case of complications.

Researchers calculated costs for 964 patients, from 12 sites, included in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry. Data were collected prospectively. A multivariate model was developed to estimate the higher costs derived from prolonged length of stay due to complications.

Mean costs for the index hospitalization were USD 17,048 ± 9904. About 14.5% of patients experienced at least one complication.

Read also: We Must Still Fear the “Big Five Complications” After TAVR.

Obviously, patients with complications had higher hospital costs (about 50% higher) and a 1.5-day longer hospital stay than patients without complications.

Seven complications were independently associated with a direct increase of costs and 6 were associated with prolonged stay.

Significant perforations and peri-procedural infarctions were the events that increased costs the most.

Read also: El acceso transcavo es seguro en el TAVI.

These costs may entail very different realities depending on where we practice medicine, so there is no possible generalization. Regardless, a cost-benefit analysis beyond money must be applied to all patients. As regards total occlusions, clinical criteria must reign. In cases with high ischemic burden in symptomatic patients, we should at least attempt the procedure, even if it is technically difficult. The opposite case would be a very simple lesion without evident ischemia (no invasive or non-invasive evidence) in an asymptomatic patient. We should avoid falling into the trap of treating such a lesion.

Conclusions

Complications have a significant impact on both costs and length of stay (without considering clinical events) for patients undergoing angioplasty for chronic total occlusion. Methods to identify high-risk patients more clearly and to develop strategies to prevent complications may reduce both events and costs.

There still are certain angioplasties that we should not even attempt without a careful risk-benefit analysis.

Original title: In-Hospital Costs and Costs of Complications of Chronic Total Occlusion Angioplasty. Insights from the OPEN-CTO Registry.

Reference: Adam C. Salisbury et al. J Am Coll Cardiol Intv 2019, article in press.

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