Assessing the economic attractiveness of coronary artery revascularization in chronic kidney disease patients

J Med Syst. 2009 Aug;33(4):287-97. doi: 10.1007/s10916-008-9190-4.

Abstract

Chronic kidney disease (CKD) is associated with increased morbidity and mortality in coronary artery disease (CAD) patients. We compared the economic attractiveness of CAD revascularization procedures in patients with and without CKD. Our population included 6218 patients with significant CAD undergoing cardiac catheterization at Duke University between 1996 and 2001, with follow-up through 2002. We investigated the influence of CKD (creatinine clearance < 60 mL/min) upon 3-year survival and medical costs in our CAD population. Coronary artery bypass graft (CABG) surgery was an economically attractive alternative vs. percutaneous coronary intervention (PCI) or medical therapy for all patients with left main disease, three-vessel CAD patients without CKD, and two-vessel CAD patients with CKD. Medical therapy was an economically attractive strategy vs. CABG surgery or PCI for three-vessel CAD patients with CKD, two-vessel CAD patients without CKD, and all single-vessel CAD patients.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / economics*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Cost-Benefit Analysis
  • Creatinine / urine
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Revascularization / economics*
  • North Carolina / epidemiology
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / economics*
  • Renal Insufficiency, Chronic / urine
  • Survival Analysis

Substances

  • Creatinine