Socio-economic aspects of coronary interventional procedures prior to coronary bypass surgery

Objectives: The aim of this retrospective study was to investigate the number and costs of patients who received angioplasty before bypass surgery.

Methods: All operated patients with triple vessel disease in our institution since January 1st 2005 were assigned to this study. The group consisted of 213 patients (mean age: 67.6 years±15 years), 170 were male (79.8%). The number of stents implanted preoperatively and the time period between last stenting and operative revascularization was studied. The calculated charges caused by different procedures are according to the OPS-code of the german DRG-system.

Results: 68 patients received preoperative coronary intervention (32%), 44 patients (21%) had coronary stent implantation before surgery with 2 stents implanted as an average. During a five year period before surgery, 34 patients (16%) had coronary stent implantation, the mean interval between the last intervention and surgery lasted 9 months. 20 pts. had significant stenosis of the left main coronary artery at the time of preoperative stent implantation and the mean interval to surgery lasted 6 months. During a five year period prior to surgery cumulative charges of coronary intervention were 9769 € per patient (without hospital or ambulant stay).

Conclusion: In Germany 2003 there were in total 222.668 percutaneous coronary angioplasties performed and 179.732 stents implanted. However, in patients with triple vessel disease coronary bypass grafting is the accepted therapy. Preoperative stenting in these patients does not avoid surgery but produces additional costs. Taking the high frequence and the high costs of stent procedures into account, a multi-center evaluation should be initiated to obtain differentiated data concerning this issue.