7 - Cost effectiveness of magnetic resonance vs. conventional guided treatment in stable coronary artery disease

Thursday, February 7

3:03 PM - 3:06 PM

Location: Grand C

Presenter(s)

Peter Bernhardt, MD

Director
Heart Clinic Ulm

Author Only(s)

CH

Carsten Hackenbroch, MD

Consultant Radiology
Department of Radiology, Armed Forces Military Hospital Ulm, Ulm, Germany
JS

Jürgen Steinacker, MD

Director of Sports Medicine
Department of Internal Medicine II, University of Ulm, Ulm, Germany
MB

Meinrad Beer, MD

Head of Radiology Department
Department of Diagnostic and Interventional Radiology, University of Ulm, Ulm, Germany
DB

Dominik Buckert, MD

Physician
Department of Internal Medicine II, University of Ulm, Ulm, Germany

Background:

Current guidelines for the appropriateness of coronary x-ray angiography (CXA) include typical angina and previous positive stress test in intermediate risk patients.

Cardiac magnetic resonance imaging (CMR) currently plays a marginal role in the daily practice work-up. Due to high diagnostic accuracy, a CMR driven management of CAD patients may reduce medical costs without negative influence on outcome. Hypothesis of our prospective and randomized trial was that CMR guided CAD therapy is more cost effective, but is not inferior regarding cardiovascular events.

Methods: On a 1:1 randomization patients presenting with typical angina, positive prior stress test other than CMR, and intermediate CAD probability were included either into a CXA or CMR guided therapy group. All patients received optimal medical therapy according to current guidelines. All CMR subjects underwent adenosine (140µg/kg/min for 3 minutes) CMR at 3 Tesla (0.075 mmol Gd-DOTA/kg). Patients in the CMR group only underwent CXA, if myocardial ischemia was detected. All patients in the CXA arm underwent CXA procedure. PCI was performed in case of significant stenosis (>75% in LAD, CX, or RCA or >50% in LM). Clinical and medical cost follow-up was performed for three years in all patients. A composite primary endpoint was defined as cardiovascular death or non-fatal myocardial infarction.

Results:

Mean per patient baseline costs for the first three months after inclusion into the study were 1,463.77 ± 174.34 €, cumulative costs after three years were 2,480.42 ± 407.36 €. Baseline costs (per patient) in the CMR group were significantly lower compared to the CXA group (1,105.71 ± 258.56 € vs. 1,864.23 ± 212.41 €, pCXA and CMR group did not differ significantly in the primary endpoint (p=0.16).

Conclusion: CMR guided CAD therapy is cost effective and does not result in higher cardiovascular events compared to conventional guided therapy. Hence, CMR can be used for a cost-effective management in patients with stable CAD.