Original paper

J Jpn Coron Assoc 2006; 12: 1-8In-hospital charge for primary coronary intervention
in patients with diabetes mellitus
Susumu Ui, Susumu Nakagawa

There is no published report regarding the difference of in-hospital charge for primary percutaneous coronary intervention (PCI) between diabetic (DM) and non-diabetic (NDM). To reveal thedifference of in-hospital charge for primary PCI between two groups, we analyzed the PCI database of our hospital and clarified the clinical variables that influenced on the in-hospital charge.
The cases presenting cardiogenic shock on admission were excluded. One-hundred and twenty-six(55 cases of DM and 71 cases of NDM) for 2 years from 2001 to 2002 were included with a followup period of average 19.6 months. In comparison between these two groups, DM was older andmore in number of female with greater incidences of prior coronary artery bypass grafting, multivessel disease (MVD) and congestive heart failure (CHF) on admission. Moreover, longer hospital stay (median, 17 vs. 13 days, p=0.0042) and higher in-hospital charge (250±122 vs. 206±84¥104
yen, p=0.0016) were statistically significant in DM. However, no clinical difference was shown
among these groups regarding the PCI outcomes and major adverse cardiac events. It is concluded that higher in-hospital charge of DM was due to longer hospital stay. This result was probably derived from some clinical characteristics of DM itself, like the trend toward more frequent
MVD and CHF.

KEY WORDS: primary percutaneous coronary intervention, acute myocardial infarction, diabetes mellitus, hospital stay, in-hospital charge

sive care for diabetic patients needs more resources than

I. Introduction

for non-diabetic patients or not.

It is known that diabetic patient with acute myocardial

II. Purpose

infarction (AMI) has a poor prognosis compared to nondiabetic patient, even though treating with reperfusion

There is no published report addressing the difference

therapy of thrombolysis or percutaneous coronary inter-of in-hospital charge of the primary PCI between diabetic

vention (PCI).1) With the development of PCI, it has been

and non-diabetic patients. We retrospectively investigatednoticed that primary PCI is more effective than throm-

our PCI database to clarify the difference of in-hospital2)bolytic therapy among diabetic patients with AMI. In

charge of the primary PCI between diabetic (DM) and non-Japan, most patients with AMI undergo primary PCI anddiabetic (NDM).

favorable outcomes were obtained compared to those in

III. Methods

other countries.3) This tendency probably results in treating many diabetic patients with AMI by primary PCI in

We retrospectively analyzed the PCI database of con-Japan. Although a procedure of PCI needs more resources

secutive AMI patients treated with primary PCI fromcompared to thrombolysis or other conservative therapies,

January 2001 to December 2002 on our PCI database.

such invasive treatment is expected to improve the prog-

These cases were clinically followed until December 2004.

nosis and advocated to be attempted for diabetic patientsFirstly, we compared the clinical characteristics between

with AMI. Nowadays there is a great question if such inva-

DM and NDM. Secondly, significant factors influencing on
the in-hospital charge were investigated.

Department of Cardiology, Tokyo Saiseikai Central Hospital, 14-17 Mita, Minato-ku, Tokyo 108-0073, Japan
Summary of this article was presented at The 18th Annual
Meeting of the Japanese Coronary Association, December 2004,
Kumamoto.
Received August 24, 2005; Accepted September 26, 2005

1. Inclusion criteria for primary PCI
In our institution, the patients with ST elevation in myocardial infarction are generally treated with primary PCI
and included in the PCI database.

―1―

J Jpn Coron Assoc 2006; 12: 1-8

AMI is defined according to the presence of two or moreof the following criteria: persistent chest pain for >30 min-

CHF is considered present on admission if the patient
has pulmonary congestion >class II with a clinical classifica-

utes, ST elevation in at least two contiguous leads of>1 mm in limb leads or >2 mm in precordial leads, respec-tion proposed by Killip et al.

tively, and a more than twofold increase of serum creati-sels, target vessel, infarct-related artery, the angiogra-

nine phosphokinase (CPK) level.4)

phical morphology by American College of Cardiology/b. Angiographic variables are the number of diseased ves-

It is required to get written informed consents from theAmerican Heart Association (ACC/AHA) classification,

patient before performing coronary angiography (CAG)

quantitative coronary analysis and ejection fraction mea-

and PCI. The usual contraindications to thrombolytic ther-sured by left ventriculography (LVG). LVG is routinely

apy, for example recent ischemic stroke or recent internal

performed just after completion of PCI. Extent of coronary

bleeding, are included.

artery disease (CAD) are expressed as one vessel disease

2. Exclusion criteria(1VD), two vessel disease (2VD), three vessel disease (3VD)

If the patient is considered to be contraindicated to CAG
and PCI or informed consent for PCI is not obtained, theseby the number of major epicardial artery with significant
stenosis of >75% angiographically. In left main trunk (LMT)

patients are excluded. Angiographical findings as thedisease, stenosis of >50% is considered significant. Target

diameter stenosis of infarct-related artery <70% withvessel means infarct-related artery with the TIMI grade

thrombolysis in myocardial infarction (TIMI) grade 3 flow

flow <2. In case of TIMI 0 or 1, the angiographical morphol-and inability to identify the infarct-related artery are also

ogy by ACC/AHA classification was diagnosed after the

excluded for primary PCI.

lesion morphology became clear, being crossed with guide-

AMI patients in cardiogenic shock with marked andwire.
c. Procedural variables are PCI procedures including

persistent hypotension with systolic arterial pressure lessplain old balloon angioplasty (POBA), cutting balloon angio-

than 80 mmHg were not eligible for this study.
3. PCI databaseplasty (CB), intracoronary stent implantation (STENT),

Our PCI database includes demographic, clinical, angio-

directional coronary atherectomy (DCA), rotational coro-graphic and procedural variables with a length of hospitalnary atherectomy (RA) and intravascular ultrasoundstay and in-hospital charge. In-hospital and out-of-hospital(IVUS). POBA means that the culprit lesion is treated only

events are also recorded.

with one or more balloons. CB means PCI is performed

a. Clinical variables are coronary risk factors (smoking,

only with one or more cutting balloons. PCI including

hypertension, hypercholesterolemia and diabetes mellitus),

STENT is carried out with one or more bare metal stents

hemo- or peritoneal dialysis, history of PCI or coronary

after conventional balloon or CB. Direct stenting is also

artery bypass graft surgery (CABG), history of old myocar-

included in the procedure of STENT. DCA means PCI isdial infarction and the presence of congestive heart failure

completed with one atherectomy catheter. RA means PCI(CHF) on admission. Positive risk factor of smoking

is completed with one or more balloons after ablation withincludes previous smoker quitting less than three years

one or more burrs. Angiographic success is defined as aago and current smoker. The diagnosis of hypertension inresidual stenosis of <50% and TIMI grade 3 flow. Proce-our database is defined as systolic blood pressure >140

dural success is defined as angiographic success without

mmHg and/or diastolic blood pressure >90 mmHg. If the

in-hospital event. In-hospital events include reinfarction,

patient has been informed of this diagnosis or is on antihy-

target lesion revascularization (TLR) during same hospi-

pertensive drugs, the presence of hypertension is defined.

talization, inguinal bleeding or hematoma which surgicalThe diagnosis of hypercholesterolemia is defined as totalcholesterol >220 mg/dl and/or low-density lipoprotein cho-repair or blood transfusion is needed and death from any

lesterol >140 mg/dl. If the patient has been informed of

culprit lesion some other day after primary PCI.

cause. Staged PCI is defined as elective PCI for the non-this diagnosis or is on lipid-lowering drugs, the presence

4. PCI proceduresof hypercholesterolemia is defined. Diabetes mellitus is

In our institute, the patients with suspected acute coro-diagnosed if the patient has been informed of this diagno-nary syndrome are initially admitted either to emergency

sis or is on prescribed anti-diabetic treatment (diet, tabletsroom or directly to coronary care unit (CCU). As soon as

and/or insulins). The patient with the blood glucose on
admission >200 mg/dl is also defined as having diabetes

the diagnosis of AMI is established, aspirin 330 mg is

mellitus.

sodium. Heparin infusion is begun at a bolus of 3,000 IU

chewed, followed by drip infusions of nitrate and heparin―2―

J Jpn Coron Assoc 2006; 12: 1-8

and titrated to keep an activated partial thromboplastin

tact with the patients.

time of 60 to 85 seconds. After informed consents for CAG

8. In-hospital charge and cost of device

and PCI are obtained, the patient is transferred to cardiac

The hospital charges were calculated from medical in-catheterization room. PCIs are mostly performed throughsurance payment. In Japan, doctors’ fees are included intransfemoral approach using 7.2 or 8.2 French sized sheath

hospital charges. Care costs for PCI are fully covered by

by at least two cardiologists. If multivessel disease (MVD)the medical insurance and paid on a fee-for-services basis.

or multiple lesions are disclosed by CAG, the target lesion
for primary angioplasty is only the culprit lesion.

Device cost was roughly estimated by the summation of
the costs for major particular therapeutic materials used

Concerning medication, glycoprotein IIb/IIIa receptor(conventional balloon, cutting balloon, bare metal stent,

antagonist (abciximab) had not been approved in Japan as

DCA, rotablator and IVUS catheters), as follows. Device

yet.

cost is presented as the sum of 200,000 yen¥the number of

5. Patient’s care following primary PCI

balloons and IVUS used, 300,000 yen¥the number of stent

All the patients treated with primary PCI are admitted

and rotablator used and 400,000 yen¥the number of DCA

to CCU. In the CCU, the serum levels of CPK are mea-

catheter used.

sured every 4 hours until CPK reaches to maximum level.

One US dollar is equivalent to 110 Japanese yen.

The patient is routinely prescribed aspirin 100 to 200 mg

IV. Statistical Analysis

per day orally, and in case of STENT, ticlopidine 100 to 200
mg per day is added. After confirming the downward

The categorical data are expressed as percent. Continu-

trend of the serum CPK level, the drip infusion of heparinous variables are generally recorded as mean±standard

is withdrawn and indwelled sheath is removed. And then,deviation (SD). Only the length of hospitalization is pre-the patient who underwent primary PCI receives cardiac

sented as median. A chi-square analysis was used to com-rehabilitation according to the program proposed by thepare dependence of categorical variables. Student’s t test

Japanese Association of Cardiac Rehabilitation.5) Thiswas used to compare the continuous variables between

guideline recommends two types of cardiac rehabilitation

two groups. Analysis of variance was used to compare thefor reperfused AMI patient during acute phase; one is a 2-means of continuous variables.

week program and the other is a 3-week one. Discharge

The process of statistical analysis was as follows. Com-

from CCU is determined by the decline of serum CPK

paring the demographic, clinical, angiographic and proce-level to the near-normal level and by the patient’s general

dural variables between DM and NDM, the characteristics

medical condition. This cardiac rehabilitation is continuedof DM were analyzed. Then the univariate analysis deter-in the general ward of the Cardiology Department until

mined the significant factors influencing on in-hospital

hospital discharge.

charge. Significant variables by the univariate analysis

6. Treatment of DM

were included in the multivariate models. Significant vari-

If the patient’s blood glucose on admission is over thanables that influenced on in-hospital charge were identified

200 mg/dl, the glucose level of capillary blood is tested

by multivariate stepwise regression test.

every 6 hours by Blood Glucose Test Meter, Glutestace

Data were analyzed using JMP Version 5.0 (SAS Cam-

RTM (Arkray Factory Co., Ltd., Japan). Regular insulin ispus Drive). A p value of <0.05 was considered statisticallyadministered to control the glucose level in the range fromsignificant.

100 to 200 mg/dl. This regimen of insulin therapy is suc-

V. Results

ceeded after admittance to the general ward. An intensified therapy for DM as the DIGAMI (Diabetes mellitus,

The number of the patients treated with primary PCIInsulin Glucose infusion in Acute Myocardial Infarction)6)

was 143 for 2 years from January 1st 2001 in our institutestudy and the Munich registry7) is not applied in our cases.

(63 cases in DM and 80 cases in NDM). The number of

7. Major adverse cardiac event (MACE)

cases with cardiogenic shock on admission was 8 in DM

After hospital discharge, cardiac death, readmission due

and 9 in NDM. These 17 cases were excluded and 126

to reinfarction, recurrent angina, CHF or TLR are diag-cases were included in our analysis. These 126 patients

nosed as MACEs. Inguinal complication such as hematoma

were divided into two groups. The number of cases belong-which surgical repair or blood transfusion is needed is also

ing to DM group was 55 (44%) and the other was 71. All the

included. These follow-up data were recorded in PCI data-

patients were followed up for the average 31.7 months.

base by reviewing the medical records or telephone con―3―

J Jpn Coron Assoc 2006; 12: 1-8
Table 1 Characteristics of diabetic (DM) and non-diabetic(NDM) treated with primary percutaneous coronary intervention from 2001 to 2002

Age (years)
Male gender (%)
Coronary risk factors
Smoking (%)
Hypertension (%)
Hypercholesterolemia (%)
Hemo- or peritoneal
dialysis (%)
History of PCI (%)
History of CABG (%)
History of OMI (%)
Lesion morphology by
ACC/AHAA (%)
B1 (%)
B2 (%)C (%)
Extent of coronary
artery disease
1VD (%)
2VD (%)
3VD (%)LMT (%)
Ejection fraction (%)
Infarct-related arteryLeft anterior
descending (%)
Left circumflex (%)
Right coronary (%)
Left main trunk (%)
Others (%)
Congestive heart
failure (%)

DM(n=55)

NDM(n=71)

p value

66±10
78

63±12
87

0.0045
0.01

57
56
48
4

64
53
58
6

ns
ns
ns
ns

24
11
13

13
1
23

ns
0.011
ns
ns

3
11
60
25

Table 2 Procedural data, outcomes and in-hospital charges ofdiabetic and non-diabetic treated with primary percutaneous
coronary intervention from 2001 to 2002
DM
(n=55)

PCI
POBA (%)
2234
CB (%)
11
5
STENT (%)
60
45
DCA (%)06
RA (%)
5
5
IVUS (%)
25
38
Procedural success (%)
96
92
MACE (%)
25
21
Volume of contrast
213±72212±55
media used (ml)Fluoroscopy time (min)
25±16
28±18
Follow-up days (day)583±311590±313
Length of hospitalization
17
13(median, day)Cost of device (¥104 yen)
47±23
45±31
(US dollar)
4273±2091 4091±2818
In-hospital charge (¥104 yen) 250±122206±84(¥103 US23±11
19±8
dollar)3
18
54
260.0017

38
25
32
5
45±12

61
26
8
5
45±8

49

44

22
22
0
7
33

20
34
1
1
8

NDM
(n=71)

p value
ns

ns
ns
ns
ns
ns
ns
0.0042ns
0.0016

Cost expressed with US dollar was calculated by estimating
one dollar equivalent to 110 yen. POBA, plain old balloon
angioplasty; CB, cutting balloon angioplasty; STENT, intracoronary stent implantation; DCA, directional coronary atherectomy; RA, rotational coronary atherectomy (rotablator); IVUS,
intravascular ultarasound; MACE, major adverse cardiac
event; DM, diabetic; NDM, non-diabetic; ns, not significant.

nsns

2. Procedural data, outcomes and in-hospital charges(Table 2)0.0005

As in Table 2, there was no significant difference among

Continuous variables are expressed as means±SD
PCI, percutaneous coronary intervention; CABG, coronary
artery bypass graft surgery; OMI, old myocardial infarction;
ACC/AHS, American College of Cardiology/American Heart
Association; VD, vessel disease; LMT, left main trunk; DM,diabetic; NDM, non-diabetic; ns, not significant.

these groups in the modality of PCI, procedural successrate, in-hospital event and MACE. The most cause of
MACE was TLR. Ten TLRs (71%) of 14 MACEs wereobserved in DM group and 13 TLRs (87%) of 15 MACEs
were in NDM group.
Diabetic patient had statistically significant trend toward
longer hospitalization and more expensive in-hospital

1. Clinical characteristics (Table 1)

charge compared to those in nondiabetic.

Among these two groups, diabetic patients were older
and more often female with a greater incidence of prior

No staged PCI or TLR was undertaken during the same
hospitalization.

CABG. Diabetics had more frequent MVD and pulmonary

3. Univariate analysis

congestion on admission. There was no significant differ-

The univariate analysis was performed among the vari-ence between two groups regarding coronary risk factors,

ables listed in Table 1 and 2 to determine the significant

an incidence of hemo- or peritoneal dialysis, prior PCI,

factors influencing on in-hospital charge. This analysis of in-prior myocardial infarction, lesion morphology class byhospital charge selected 10 significant factors including

ACC/AHA, the distribution of infarct-related artery andhospital stay (p<0.0001), hemo- or peritoneal dialysis (p=ejection fraction by LVG.

0.0009), ACC/AHA lesion class (p=0.0016), CHF (p=0.0035),―4―

J Jpn Coron Assoc 2006; 12: 1-8
Table 3 Multivariate stepwise regression test among the variables selected by univariate analysis regarding in-hospitalcharge, after excluding the variables of hospital stay and hemoor peritoneal dialysis from analysis
Variables

R2

F valuep value

Extent of coronary arterydiseaseLesion morphology by
ACC/AHA
Congestive heart
failureDiabetes mellitus
Fluoroscopy time
Cost of device
History of PCI
Age

0.21

8.896

0.0035

0.12

7.584

0.0069

0.25

5.903

0.0168

0.28
0.27
0.29
―
―

1.742
1.734
1.364
0.601
0.550

ns
ns
ns
ns
ns

ACC/AHS, American College of Cardiology/American Heart
Association; PCI, percutaneous coronary intervention; ns, notsignificant.

of longer hospitalization and more expensive in-hospitalcharge. Because this result was considered to be due tohemo- or peritoneal dialysis itself, we excluded this factor
from the analysis. And multivariate stepwise regression
Fig. 1 Influences of hemo- or peritoneal dialysis on hospital
stay and in-hospital charge.
A. The length of hospitalization with or without hemo- or peritoneal dialysis (p<0.0001).
B. In-hospital charge with or without hemo- or peritoneal dialysis (p=0.0009).

test was performed again, among the 8 variables after
excluding the variable of hemo- or peritoneal dialysis fromthe last 9 factors.
6. Finally as in Table 3, three variables were selected
as more significant factor influencing on in-hospital charge;
extent of CAD (F=8.896, p=0.0035), ACC/AHA lesion classextent of CAD (p=0.0091), age (p=0.03), cost of device (p=(F=7.584, p=0.0069) and CHF (F=5.903, p=0.0168). Figure 2

0.033), fluoroscopy time (p=0.034), prior PCI (p=0.037) andmade it clear that these three variables were independent

DM (p=0.04).

predictors of in-hospital charge.

4. Multivariate stepwise regression test

VI. Discussion

Multivariate stepwise regression test was performed
among the 9 variables selected by the univariate analysis

1. Review of the trials and registries reported, regarding

regarding in-hospital charge, after excluding the variablediabetic and non-diabetic AMI patients treated withreperfusion therapies

of hospital stay. Five variables were selected as the significant factor influencing on in-hospital charge; extent ofIn the history of the treatments for AMI, many trials

CAD (F=9.677, p=0.0024), hemo- or peritoneal dialysis (F=and registries have proved that both thrombolysis and pri-

6.148, p=0.0147), CHF (F=5.874, p=0.017), cost of device

mary PCI are effective strategies to reperfuse the infarct-(F=4.585, p=0.033) and ACC/AHA lesion class (F=4.524,

related artery as soon as possible after symptom onset.8, 9)

p=0.0016). The parameters of age, fluoroscopy time, prior

Such reperfusion of the occluded coronary artery contrib-

PCI and DM were excluded.

utes to reduce postinfarction morbidity and mortality dur-

The most significant factor that influenced on in-hospitaling both early and late stage of AMI.10-12) It has beenrecognized that diabetes mellitus is undoubtedly indepen-charge was identified to be the length of hospital stay.
5. Influences of hemo- or peritoneal dialysis on hospitaldent predictor of in-hospital and out-of-hospital cardiac
events.13-19) As diabetes mellitus is one of the high-risks tostay and in-hospital charge
The influences of hemo- or peritoneal dialysis on theworsen the prognosis of the patients with AMI, high-risk

length of hospitalization and in-hospital charge were

patients with DM are more likely than low-risk patients toshown in Fig. 1. As we expected, the patients undergoing

benefit from primary PCI.20) Immediate success rates after

hemo- or peritoneal dialysis have primarily a trend toward

PCI are similar for patients with and without diabetes.

―5―

J Jpn Coron Assoc 2006; 12: 1-8

microvasculature,22) autonomic dysfunction and platelet
and coagulation abnormalities are contributing to left ventricular dysfunction23) and poor prognosis of diabetes.
2. Our resultsa. Longer hospitalization of diabetes: In our cases, although there was no significant difference regarding theleft ventricular ejection fraction between DM and NDM,
higher incidence of CHF was observed in DM. This result
may imply that our diabetic patients tended to have notsystolic but diastolic failure. Diffuse atherosclerotic lesionof the coronary artery also contributed to diastolic dysfunction of the left ventricle along with microvasculatureabnormality. These several factors might decrease cardiac
reserve after AMI, resulting in delayed convalescence andlonger hospitalization. As there was no significant difference between two groups regarding PCI related variables
such as entire fluoloscopy time, volume of contrast media
used and cost of devices used, we can imagine that longer
hospital stay of diabetes was due not to the process of PCI
procedure but to other factors including CHF as mentioned above.
b. More resources for diabetes treated with primary PCI:
It is also clarified in our study that more expensive inhospital charge of diabetes was due to longer hospitalization. In the Munich registry, hospital stay were comparable between DM and NDM (14.1±9.5 vs. 14.5±9.0 days, respectively).7) The cause of such difference from our result
is suspected to be due to multifactorial, for example, thedifference of rehabilitation program compared to that inGermany.
Moreover, in order to shorten the hospital stay of diabeFig. 2 Three independent predictors of in-hospital charge
selected by multivariate stepwise regression analysis, after
excluding the variables of hospital stay and hemo- or peritoneal
dialysis from analysis.
A. The relation between extent of coronary artery disease andin-hospital charge (p=0.0035).
B. The relation between lesion morphology by American College of Cardiology/American Heart Association (ACC/AHA)
lesion class and in-hospital charge (p=0.0069).
C. The relation between congestive heart failure on admission
and in-hospital charge (p=0.0168). CHF, congestive heart failure.

tes with AMI, meticulous medical treatment for diabetic
status along with the therapy of CHF is mandatory.
c. Prognosis after primary PCI: MACEs were also comparable between our two groups. In our cases, some patients
had already been prescribed with lipid-lowering drugs like
HMG-CoA reductase inhibitor before primary PCI. Therefore, the characteristic of atherosclerotic plaque might bemodified by such medications and substantially different
from that of untreated diabetic patients.
In the present new-device era, for example, drug eluting
stent (DES) is expected to improve the poor prognosis of

However, the incidence of MACEs generally is higher

diabetes.24) However, DES is at present approved not foramong patients with diabetes. Moreover, long-term mortal-

AMI patient but for elective case. We hope that the indica-

ity is much higher for patients with diabetes.

tion of DES for AMI will be studied in near future.

The etiology of poor prognosis of diabetes with AMI has

d. Finally, primary PCI for diabetes contributed tobeen discussed throughout the world and has been attrib-

reduce both the early and late cardiac events. Although

uted to several factors. Diffuse coronary atherosclerosis,

longer hospital stay and more expensive in-hospital charge

endothelial dysfunction,21) disease of the coronary artery

were observed in the diabetic patients treated with pri-

―6―

J Jpn Coron Assoc 2006; 12: 1-8

mary PCI, it may be no exaggeration to say that the im-

PCI were comparable between DM and NDM. It is

provement of the prognosis compensates more resources

expected for the primary PCI that such intensive care forused for acute phase of AMI.

acute phase results in cost-effective treatment for longterm prognosis.

VII. Study Limitation
1. Patients selection

References

The patients enrolled in our study were limited to the
AMI patients treated with primary PCI. The cases treated
without primary PCI were excluded. The fact is thathigher-risk patients had more severe CHF and were notcandidate for primary PCI. These more severe AMI
patients were mostly treated with conservative therapy ordeferred PCI. Such selection bias toward including thepatients with less severe complications probably favored
better prognosis after AMI.
2. Treatment before primary PCI and patients’ medical
conditions
Incidence of DM accounted for 44% of all the patients
who underwent primary PCI. This high incidence of DM
maybe means that more patients were already on antidiabetic treatment, demonstrating the characteristics of
our institute. In our PCI database, the modality of treatment and medical condition of diabetes mellitus were notincluded. For example, the blood glucose level after AMI
is an independent predictor of long-term mortality inpatients with and without known diabetes mellitus.25)
Blood glucose level with the level of HbA1c should bemonitored.
3. The length of stay in CCU
Referring to in-hospital charge, we can imagine that
longer the patient stays in CCU, more expensive inhospital charge is. The length of stay in CCU must be
longer for the patients with complications and it isexpected that diabetes with AMI and CHF stays longer
with a delayed rehabilitation. It was not clear in our record
how long the patients stayed in CCU.
4. Cost-effectiveness of primary PCI for diabetes
Cost-effectiveness should be evaluated in the long-termclinical course. To prove the favor of primary PCI for diabetes, it is necessary to compare the diabetes treated without primary PCI to those treated with it in longer clinicalcourse.

VIII. Conclusion
Higher in-hospital charge of DM was due to its longer
hospital stay. The clinical characteristics of DM itself, forexample, higher incidence of MVD and CHF, were contributing to using more resources in the invasive treatment.
However, short-term and long-term outcomes of primary

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