ECONOMIC AND ANGIOGRAPHIC FACTORS IN DETERMINING OPTIMAL CATHETER SIZE IN PERFORMING OUTPATIENT LEFT-SIDED HEART AND CORONARY ANGIOGRAPHY

A prospective randomized trial was performed in 300 patients to establ ish the optimal catheter size (5.2, 6, or 7Fr) in performing outpatien t left heart and coronary arteriography, A secondary randomization was performed between an attending physician and cardiovascular fellow to determine if the experience level of the operator was an important fa ctor when using smaller French-sized catheters, The primary end point of the trial was total resource utilization of the patient's hospitali zation. Hospital cost was calculated with cost accounting methodology using a ''bottom-up'' approach, and physician ''cost'' was determined with the Resource-Based Relative Value Scale. Angiographic quality was graded with qualitative and quantitative methods, Procedures were fas ter and time to hemostasis shorter with smaller catheters. The more ex perienced operators performed faster procedures and used less fluorosc opy. In the cardiac catheterization laboratory, health-care personnel cost was higher with the 6Fr catheters and when the attending physicia n was the primary operator, Postprocedure care was slightly less expen sive with the smaller catheters. Overall, there was no difference in t otal cost between the catheter sizes and primary operators, Angiograph ic quality was similar between the catheter sizes. Smaller catheters u sed in performing outpatient left-sided heart and coronary arteriograp hy are not associated with cost savings but do not compromise angiogra phic quality.