A Prospective Randomized Trial of 0.010" Versus 0.014" Balloon PTCA Systems and Interventional Fellow Versus Attending Physician as Primary Operator in Elective PTCA: Economic, Technical, and Clinical End Points

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Abstract
The cost of performing percutaneous transluminal coronary angioplasty (PTCA) is accelerating. The angiographic, clinical, technical, and procedural variables associated with PTCA cost are largely unknown. To determine an interrelationship between equipment size, operator experience, and PTCA cost, 50 patients were randomized to have PTCA performed with large (0.014") or small (0.010") balloon systems. A secondary randomization determined the primary operator of the procedure; either experienced attending physician or inexperienced fellow in interventional cardiology. Primary: PTCA cost (equipment, supplies, support personal, post-PTCA room, and physician (utilizing resource-based relative value scale); Secondary: measures of technical procedural and clinical outcome. The total cost of the PTCA was $4,047 +/- $2,133 for 0.010" systems versus $3,451 +/- $1,004 for the 0.014" systems, P = NS. Independent variables associated with increased cost included: age, diabetes, and duration of procedure in the cardiac catheterization laboratory. There was no significant difference in procedural duration, complications, or outcome between the smaller or larger PTCA catheter systems, and, the less experienced PTCA operator required additional fluoroscopic time to cross the lesion, as well as procedure time compared with the attending physician. Neither miniaturization of equipment size nor primary operator experience led to PTCA cost savings. Clinical and procedural characteristics are independently correlated with increased PTCA cost. Additional study is needed to determine the exact determinants of PTCA cost, in order to stabilize the cost of this procedure.