Interventional Cardiology Unit Research Articles

Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit

Growing interest in the use of drug-eluting stents (DESs) in coronary angioplasty has prompted the Healthcare Agency of the Emilia Romagna Region to draw up recommendations for their appropriate clinical use in high-risk patients. Since the adoption of any new technology necessitates economic appraisal, we analysed the resource consumption of the various types of angioplasty procedures and the impact on the budget of a cardiology department. A retrospective economic appraisal was carried out on the coronary angioplasty procedures performed in 2004 in the Department of Interventional Cardiology of Reggio Emilia. On the basis of the principles of activity-based costing, detailed hospital costs were estimated for each procedure and compared with the relevant diagnosis-related group (DRG) reimbursement. In 2004, the Reggio Emilia hospital performed 806 angioplasty procedures for a total expenditure of euro 5,176,268. These were 93 plain old balloon angioplasty procedures (euro 487,329), 401 procedures with bare-metal stents (euro 2,380,071), 249 procedures with DESs (euro 1,827,386) and 63 mixed procedures (euro 481,480). Reimbursements amounted to euro 5,816,748 (11% from plain old balloon angioplasty, 50% from bare-metal stent, 31% from DES and 8% from mixed procedures) with a positive margin of about euro 680,480 between costs incurred and reimbursements obtained, even if the reimbursement for DES and mixed procedures was not covering all the incurred costs. Analysis of the case-mix of procedures revealed that an overall positive margin between costs and DRG reimbursements was achieved. It therefore emerges that adherence to the indications of the Healthcare Agency of the Emilia Romagna Region for the appropriate clinical use of DESs is economically sustainable from the hospital enterprise point of view, although the DRG reimbursements are not able to differentiate among resource consumptions owing to the adoption of innovative technologies.

Evolución en los últimos 20 años en el perfil demográfico, epidemiológico y clínico, técnica y resultados de los procedimientos coronarios percutáneos

Introduction and objectives The aim of this study was to describe the changes observed in clinical practice in our interventional cardiology unit over the last 20 years. Methods Between January 1, 1986 and December 31, 2005, ≥17 204 percutaneous transluminal coronary angioplasties (PTCAs) were performed at our center. They were analyzed in four periods of 5 years each. After each procedure, prospective data on patient, procedural, and outcome variables were recorded. The data were analyzed with regard to when the procedure was performed, and the patients’ sex and age (i.e., < or ≥75 years). Data from 2006 were used as a reference, but were not included in the analysis. Results The number of PTCAs increased significantly. Over the time period, mean patient age increased (from 57[10] years to 62[12] years for males and from 66[10] years to 70[11] years for females), and there were significant increases in the proportions of women (from 16% to 22%) and patients aged >75 years (from 7% to 22%). Among men, the incidence of smoking decreased while that of hypertension, diabetes and hyperlipemia increased. Among women, however, there was no change in risk factors. The numbers of urgent and emergent procedures (17% of PTCAs were for acute myocardial infarction in 2006) increased in both sexes and age groups, more ad hoc procedures were carried out, and more lesions were treated, usually with a stent. Over time, the success rate increased and the complication rate decreased in both sexes and age groups. In-hospital mortality for all procedures, except those for acute myocardial infarction, was 0.7% in males and 1.4% in females (P=.012). Conclusions Significant changes were observed over the last 20 years in the baseline characteristics of, the techniques used in, and the outcomes obtained in patients undergoing percutaneous coronary intervention.

Functional Subclavian Artery Compression Caused by Thoracic Outlet Syndrome

HomeCirculationVol. 112, No. 17Functional Subclavian Artery Compression Caused by Thoracic Outlet Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBFunctional Subclavian Artery Compression Caused by Thoracic Outlet Syndrome Gianluca Rigatelli, MD, Massimo Rinuncini, MD, Loris Roncon, MD, Massimo Giordan, MD and Pietro Zonzin, MD Gianluca RigatelliGianluca Rigatelli From the Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Verona, Italy. Search for more papers by this author , Massimo RinunciniMassimo Rinuncini From the Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Verona, Italy. Search for more papers by this author , Loris RonconLoris Roncon From the Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Verona, Italy. Search for more papers by this author , Massimo GiordanMassimo Giordan From the Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Verona, Italy. Search for more papers by this author and Pietro ZonzinPietro Zonzin From the Interventional Cardiology Unit, Division of Cardiology, Rovigo General Hospital, Verona, Italy. Search for more papers by this author Originally published25 Oct 2005https://doi.org/10.1161/CIRCULATIONAHA.104.521054Circulation. 2005;112:e280–e281A 68-year-old hypertensive man was admitted to our center for a non-ST-elevation acute coronary syndrome with normal troponin value. The clinical history was remarkable for enabliting pain of the left upper arm. After a positive stress test, the patient was scheduled for coronary angiography. The coronary angiography revealed severe 3-vessel coronary artery disease and a slight impairment of left ventricular function. Because the patient appeared to be a candidate for coronary surgery via the left internal mammary artery, a subclavian artery angiography was performed in the same session to exclude any subclavian artery stenosis and assess the suitability of the internal mammary artery as an arterial conduit. A tight stenosis of the middle portion of the left subclavian artery was detected (Figure, A). Because we believed that the patient had thoracic outlet syndrome (TOS), the patient’s left arm was mildly adducted and a magnified subclavian angiogram performed. The angiogram revealed that the stenosis appeared to be mild (Figure, B). After maximally adducting the left arm, the stenosis completely disappeared (Figure, C), confirming a phasic compression of the subclavian artery. TOS uncommonly causes arterial vascular complications; bony or muscular abnormalities such as abnormal cervical ribs, fibrous bands, or other variations of scalene musculature can lead to chronic trauma to the subclavian artery or the brachial plexus. Diagnosis is made by Doppler ultrasound or MRI. Surgical excision of the first cervical ribs or scalene muscle with or without vascular reconstruction is the treatment of choice. In rare instances, the angiography of the subclavian artery may detect a previously undiagnosed TOS. Download figureDownload PowerPointA, Subclavian artery angiography with semiselective visualization of left internal mammary artery: in antero-posterior view a tight stenosis of the middle left subclavian artery is detected. B, After mildly adducting left arm, stenosis became moderate. C, After maximally adducting left arm, stenosis completely disappeared.FootnotesCorrespondence to Gianluca Rigatelli, MD, FACC, FESC, FSCAI, FCCP, Via T. Speri 18, 37040 Legnago, Verona, Italy. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Campbell W and Landau M (2008) Controversial Entrapment Neuropathies, Neurosurgery Clinics of North America, 10.1016/j.nec.2008.07.001, 19:4, (597-608), Online publication date: 1-Oct-2008. October 25, 2005Vol 112, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.104.521054PMID: 16246953 Originally publishedOctober 25, 2005 PDF download Advertisement SubjectsImaging

New diagnostic methods in interventional cardiology.

Journal of Interventional CardiologyVolume 7, Issue 1 p. 41-41 New Diagnostic Methods in Interventional Cardiology HERBERT J. GESCHWIND M.D., Corresponding Author HERBERT J. GESCHWIND M.D.Address for reprints: Herbert J. Geschwind, Professor University of Paris XI, Director, Cardiac Catheter Laboratory and Interventional Cardiology Unit, University Hospital Henri Mondor, University of Paris XII, Creteil, France. Fax: 011-33-1-49-81-2667.Search for more papers by this author HERBERT J. GESCHWIND M.D., Corresponding Author HERBERT J. GESCHWIND M.D.Address for reprints: Herbert J. Geschwind, Professor University of Paris XI, Director, Cardiac Catheter Laboratory and Interventional Cardiology Unit, University Hospital Henri Mondor, University of Paris XII, Creteil, France. Fax: 011-33-1-49-81-2667.Search for more papers by this author First published: February 1994 https://doi.org/10.1111/j.1540-8183.1994.tb00888.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume7, Issue1February 1994Pages 41-41 RelatedInformation

New diagnostic methods in interventional cardiology.

Journal of Interventional CardiologyVolume 6, Issue 4 p. 319-320 New Diagnostic Methods in Interventional Cardiology HERBERT J. GESCHWIND M.D., Corresponding Author HERBERT J. GESCHWIND M.D.Address for reprints: Herbert J. Geschwind, Professor University of Paris XI, Director, Cardiac Catheter Laboratory and Interventional Cardiology Unit, University Hospital Henri Mondor, University of Paris XII, Creteil, France. Fax: 011-33-1-49-81-2667.Search for more papers by this author HERBERT J. GESCHWIND M.D., Corresponding Author HERBERT J. GESCHWIND M.D.Address for reprints: Herbert J. Geschwind, Professor University of Paris XI, Director, Cardiac Catheter Laboratory and Interventional Cardiology Unit, University Hospital Henri Mondor, University of Paris XII, Creteil, France. Fax: 011-33-1-49-81-2667.Search for more papers by this author First published: December 1993 https://doi.org/10.1111/j.1540-8183.1993.tb00875.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume6, Issue4December 1993Pages 319-320 RelatedInformation

Case management with the nurse manager in the role of case manager in an interventional cardiology unit.

Varying external and internal factors are motivating changes in how physicians and nurses deliver patient care within health-care institutions. A care delivery system that has received increasing attention in the literature is case management. This chapter describes how a community hospital implemented case management for patients undergoing percutaneous coronary angioplasty and cardiac catheterization while developing the new role of clinical manager to serve in the role of case manager. The process for planning and implementing such a role change is discussed, and initial evaluative data are presented.