Article Text

The economic burden of complications during percutaneous coronary intervention
  1. Kurt M Jacobson1,
  2. Kirsten Hall Long2,
  3. Erin K McMurtry2,
  4. James M Naessens2,
  5. Charanjit S Rihal3
  1. 1Division of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Division of Health Care Policy & Research, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to:
 Charanjit S Rihal
 Mayo Clinic, 200 First Street SW, Rochester, Minnesota, USA;rihal{at}


Background: Technological advances have enabled percutaneous coronary intervention (PCI) to be applied with expanding indications. However, escalating costs are of concern. This study assessed the incremental medical costs of major in-hospital procedural complications incurred by patients undergoing PCI.

Methods: We considered all patients undergoing elective, urgent, or emergent PCI at Mayo Clinic Rochester between 3/1/1998–3/31/2003 in analyses. Clinical, angiographic, and outcome data were derived from the Mayo Clinic PCI Registry. In-hospital PCI complications included major adverse cardiac and cerebrovascular events (MACCE) and bleeding of clinical significance. Administrative data were used to estimate total costs in standardised, year 2004, constant-US dollars. We used generalised linear modeling to estimate costs associated with complications adjusting for baseline and procedural characteristics.

Results: 1071 (13.2%) of patients experienced complications during hospitalisation. Patients experiencing complications were older, more likely to present with emergent PCI, recent or prior myocardial infarction, multi-vessel disease, and comorbid conditions than patients who did not experience these events. Unadjusted total costs were, on average, $27 865±$39 424 for complicated patient episodes compared to $12 279±$6796 for episodes that were complication free (p<0.0001). Adjusted mean costs were $6984 higher for complicated PCIs compared with uncomplicated PCI episodes (95% CI of cost difference: $5801, $8168). Incremental costs associated with isolated bleeding events, MACCE, or for both bleeding and MACCE events were $5883, $5086, and $15 437, respectively (p<0.0001).

Conclusions: This high-volume study highlights the significant economic burden associated with procedural complications. Resources and systems approaches to minimising clinical and economic complications in PCI are warranted.

Statistics from


  • Funding: Mayo Foundation for Medical Education and Research.

  • Competing interest: None.

  • Previous presentation: Presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research 8th Annual European Congress; November 7, 2005; Florence, Italy. Additional oral presentation occurred at the Inaugural Conference of the American Society of Health Economists; June 6, 2006; Madison, Wisconsin, USA.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.