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Reuse of balloon catheters for coronary angioplasty: a potential cost-saving strategy?
S Plante1, B H Strauss, G Goulet
1Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke, Canada.
Insights
Catheter reuse in coronary angioplasty was linked to more adverse events and longer procedures compared to single-use catheters. Further randomized trials are needed to confirm safety and cost-effectiveness.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Economics
Background:
- Coronary angioplasty is a vital yet costly medical procedure.
- To manage healthcare expenses, some institutions routinely reuse angioplasty catheters.
- This practice contrasts with single-use strategies employed elsewhere.
Purpose of the Study:
- To evaluate the effectiveness, safety, and costs of reusing angioplasty catheters.
- To compare catheter reuse with a single-use strategy in a contemporary setting.
Main Methods:
- A prospective observational study was conducted over 10 months.
- Data were collected via forms completed after each angioplasty procedure.
- Patient data were gathered before discharge.
Main Results:
- Identical angiographic success rates (88%) were observed in both reuse and single-use centers.
- The reuse center showed higher rates of initial balloon failure (10.2% vs. 3.3%) and adverse clinical events (7.8% vs. 3.8%).
- Catheter reuse was associated with increased balloon catheter use per lesion, prolonged procedure times, and greater contrast medium volume.
Conclusions:
- Catheter reuse correlated with increased adverse events, longer procedure times, and higher contrast medium use, particularly in complex lesions and unstable angina patients.
- The observational nature of the study limits definitive conclusions on causality.
- A multicenter randomized trial is recommended to ascertain the safety and cost-benefit ratio of catheter reuse.
Objectives:
This study was designed to determine the effectiveness, safety and costs associated with reuse of angioplasty catheters and to compare these results with those of a contemporary center that employed a single-use strategy.
Background:
Coronary angioplasty is an important but expensive procedure. To overcome the financial constraints of the Canadian health care system, reuse of angioplasty catheters is routinely practiced in some institutions.
Methods:
In a prospective observational study, data forms were completed after each angioplasty procedure and before patient discharge over a 10-month period.
Results:
A total of 693 patients underwent coronary angioplasty in the two centers. Clinical and lesion characteristics were similar except for a higher incidence of unstable angina at the reuse center (p < 0.005). The angiographic success rate was identical (88%) at both centers. The reuse center utilized more balloon catheters/lesion (mean +/- SD 2.4 +/- 1.5 vs. 1.2 +/- 0.5, p < 0.00001) and had a higher incidence of initial balloon failure (10.2% vs. 3.3%, p < 0.0001). Significant prolongation of the procedure time (81 +/- 41 vs. 68 +/- 32 min, p < 0.0001) and increased volume of contrast medium (201 +/- 86 vs. 165 +/- 61 ml, p < 0.0001) were seen in the reuse center. A higher rate of adverse clinical events (7.8% vs. 3.8%, p < 0.025) was observed in the reuse center, especially in patients with unstable angina.
Conclusions:
The reuse strategy was associated with a higher rate of adverse events, prolonged procedure time and increased use of contrast medium, especially in lesions that were not crossed by the initial balloon and in patients with unstable angina. Whether these differences are related to the reuse strategy or to differences in patient groups cannot be ascertained by this observational study. A multicenter randomized trial is required to further assess the safety and the cost/benefit ratio of this strategy.