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Mehaffey JH, Hayanga JWA, Kawsara M, Sakhuja A, Mascio C, Rankin JS, Badhwar V. Contemporary Coronary Artery Bypass Grafting vs Multivessel Percutaneous Coronary Intervention. Ann Thorac Surg 2023; 116:1213-1220. [PMID: 37353103 PMCID: PMC10739562 DOI: 10.1016/j.athoracsur.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/03/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Interpretation of recent alterations to the guideline priority of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease contests historical data and practice. To reevaluate contemporary outcomes, a large contemporary analysis was conducted comparing CABG with multivessel PCI among Medicare beneficiaries. METHODS The United States Centers for Medicare and Medicaid Services database was evaluated all beneficiaries with acute coronary syndrome undergoing isolated CABG or multivessel PCI (2018-2020). Risk adjustment was performed using multilevel regression analysis, Cox proportional hazards time to event models, and inverse probability of treatment weighting propensity scores. RESULTS A total of 104,127 beneficiaries were identified undergoing CABG (n = 51,389) or multivessel PCI (n = 52,738). Before risk adjustment, compared with PCI, CABG patients were associated with younger age (72.9 vs 75.2 years, P < .001), higher Elixhauser Comorbidity Index (5.0 vs 4.2, P < .001), more diabetes (48.5% vs 42.2%, P < .001), higher cost ($54,154 vs $33,484, P < .001), and longer length of stay (11.9 vs 5.8 days, P < .001). After inverse probability of treatment weighting propensity score adjustment, compared with PCI, CABG was associated with lower hospital mortality (odds ratio, 0.74; P < .001), fewer hospital readmissions at 3 years (odds ratio, 0.85; P < .001), fewer coronary reinterventions (hazard ratio, 0.37; P < .001), and improved 3-year survival (hazard ratio, 0.51; P < .001). CONCLUSIONS Contemporary real-world data from Medicare patients with multivessel disease reveal that CABG outcomes were superior to PCI, providing important longitudinal data to guide patient care and policy development.
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Affiliation(s)
- J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
| | - J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Mohammad Kawsara
- Division of Cardiology, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Ankit Sakhuja
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Christopher Mascio
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia
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Prasad A, Gersh BJ. Stable Coronary Artery Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Li ZZ, Wu XY, Tao Y, Wang S, Yin CQ, Gao YL, Cheng YT, Li Z, Ma CS. Revascularization versus drug therapy for coronary artery disease in patients aged over 80 years: a real-world study. Cardiovasc Diagn Ther 2020; 10:512-519. [PMID: 32695630 DOI: 10.21037/cdt-20-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Revascularization for the treatment of coronary artery disease (CAD) is advancing rapidly and is used increasingly in old patients. This study aimed to compare the efficacy and safety of revascularization with drug therapy in CAD patients aged over 80 years at a real-world clinical setting. Methods A total of 501 CAD patients aged over 80 years were consecutively enrolled from January 2011 to January 2016 in Anzhen Hospital (Beijing, China), Capital Medical University. The patients were treated with percutaneous coronary intervention (PCI) (n=283), coronary artery bypass grafting (CABG) (n=106), or drug therapy (n=112). All-cause mortality, cardiovascular-related mortality, readmission rate, and Seattle Angina Questionnaire (SAQ) score were compared between the three treatment methods. Results A total of 411 patients (82.04%) were followed with a median duration of 25 months. All-cause mortality and cardiovascular-related mortality in the drug therapy group were significantly higher than the PCI and CABG groups (both P<0.05). Readmission rate for cardiovascular events in the CABG group was significantly lower than the PCI and drug therapy groups (both P<0.05). Scores of physical limitation, angina frequency, treatment satisfaction, and disease perception of the SAQ in the PCI and CABG groups were significantly higher than the drug therapy group (both P<0.05). Scores of angina stability did not differ significant between the three groups (P=0.127). Conclusions Revascularization is superior to drug therapy in efficacy and safety in the treatment of oldest-old patients with CAD.
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Affiliation(s)
- Zhi-Zhong Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Wu
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Tao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Su Wang
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cheng-Qian Yin
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Long Gao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Tong Cheng
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhao Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Clinical efficacy of different treatments and their impacts on the quality of life of octogenarians with coronary artery disease. Chin Med J (Engl) 2020; 132:2657-2663. [PMID: 31725445 PMCID: PMC6940100 DOI: 10.1097/cm9.0000000000000504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Coronary artery disease (CAD) in octogenarians (age of ≥80 years) has a high risk of mortality and high medical expenses. Research shows that the prevalence of CAD is higher among octogenarians than that among younger people, but few such patients undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study aimed to evaluate different treatments with respect to their clinical effects and impacts on quality of life of octogenarians with CAD. Methods: Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital, Capital Medical University (Beijing, China) from January 2010 to January 2016 were collected in this study. The patients were categorized into three groups based on the treatments they received: the PCI group (n = 292), CABG group (n = 110), and medical treatment group (n = 117). The followings were recorded during follow-up: clinical data, death (all-cause and cardiovascular-related), re-hospitalization time, Seattle Angina Questionnaire (SAQ) score, and occurrence of hemorrhagic events (cerebral bleeding, gastrointestinal bleeding, and dermal ecchymosis). Results: The median follow-up duration was 25.0 (25th, 75th percentile: 17.0, 55.5) months among 417 patients. The all-cause death rates (28.2% vs. 12.0% and 14.6%, respectively) and cardiovascular-related death rates (15.4% vs. 3.8% and 6.4%, respectively) were significantly higher in the medical treatment group than those in the PCI group and CABG group (all P < 0.05). The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group (3.8% vs. 12.8% and 14.9%, respectively) (χ2 = 8.238, P = 0.018). The SAQ scores of physical limitation, angina frequency, treatment satisfaction, and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group (all P < 0.05). No significant difference in the angina stability score was observed among the three groups (F = 3.179, P = 0.204). Conclusion: PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.
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Influence of Prior Coronary Stenting on the Immediate and Mid-term Outcome of Isolated Coronary Artery Bypass Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 2:217-25. [DOI: 10.1097/imi.0b013e31815bdbc1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background There has been little emphasis on the possible consequences of prior stent placement on the outcome of coronary bypass surgery (CABG). We compared the results of isolated CABG patients who had prior stents with those who had not with respect to preoperative status, operative procedure, and postoperative immediate and long-term outcome. Methods Records of 1471 patients undergoing isolated CABG at our institution between January 1, 2000, and March 31, 2005, were reviewed. Patients were divided into three groups. Group I had no stents (n = 1317). Group II had one to three stents (n = 137). Group III had more than three stents (n = 17). Groups were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Long-term survival data were obtained on 97.6% of patients with a mean follow-up, 4.1 ± 2.3 years. Results Stented patients were younger (66.1 ± 10.8 vs. 69.1 ± 10.8 years, P = 0.006), had more unstable angina (68.2% vs. 58.9%, P = 0.02), hypercholesterolemia (83.8% vs. 61.2%, P = 0.00), chronic obstructive pulmonary disease (13.6% vs. 8.4%, P = 0.03), peripheral vascular disease (15.2% vs. 8.4%, P = 0.00), and previous CABG (10.1% vs. 4.2%, P = 0.00), fewer low ejection fractions (1.3% vs. 5.2%, P = 0.02), left main disease (25.3% vs. 32.6%, P = 0.04), diabetes (31.2% vs. 40.8%, P = 0.01), or diffuse disease (19.5 ± 10.5 vs. 22.5 ± 10.9, P = 0.00), had more off pump procedures (53.2% vs. 45.3%, P = 0.03), fewer internal thoracic artery grafts (80.5% vs. 86.6%, P = 0.03), fewer grafts placed (>3: 52.6% vs. 61.8%, P = 0.02), more complications (76.5% vs. 42.6%, P = 0.005), atrial fibrillation (47.1% vs. 19.7%, P = 0.011), longer hospital stays (12.2 vs. 8.3 days, P = 0.019). Percentage survival for groups I, II, and III at 60 months was 82.1%, 84.7%, and 72.6%, respectively. Conclusions Stents placed before surgery in isolated CABG patients may be associated with higher preoperative risk, altered operative procedures, more postoperative complications, longer hospitalizations, and more readmissions. Overall, stented patients experienced more preoperative hospitalizations, catheterizations, and percutaneous coronary interventions (PCIs) than nonstented patients. Survival for those with more than three stents may be diminished.
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Gunn J, Taggart DP. Transcatheter versus surgical intervention: lessons from trials of coronary revascularisation. Heart 2019; 105:s44-s49. [DOI: 10.1136/heartjnl-2018-313518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
In this paper, a cardiac surgeon and an interventional cardiologist draw lessons from the trials of percutaneous coronary intervention/coronary artery bypass graft surgery (PCI/CABG) for the transcatheter aortic valve implantation/surgical aortic valve replacement (TAVI/SAVR) era. Both PCI and CABG are effective treatments, but do the trials ask the right questions? They dwell on the ‘either/or’ decision for selected patients suitable for both treatments, but provide little guidance for the majority of ‘real world’ patients with comorbidities precluding CABG, or complex coronary heart disease precluding PCI. The control group must be meaningful and relevant. The pace of technological and therapeutic change causes trials to date rapidly. Procedures often do not reflect everyday practice, such as performing multivessel PCI, copious stenting and full arterial grafting. Composite endpoints such as major adverse cardiovascular and cerebrovascular events (MACCE) provide statistical significance but little insight into patient-orientated needs. There is a variety of temporal, safety, symptomatic and prognostic endpoints, provoking debate over their relative and absolute magnitude and importance; and there are issues of interpretation and inappropriate extrapolation. Trial interpretation, crystallised in the Kaplan-Meier curve, focuses on the relative benefit of one treatment over another, but deserves careful scrutiny. Subgroup analysis tends to exceed its role in dealing with issues such as poor left ventricular function, diabetes, multivessel disease and proximal left anterior descending coronary artery stenosis. Meta-analysis is controversial and guidelines date rapidly, lacking robust evidence in some domains, yet assuming considerable importance. Measures of frailty, physiological measures of blood flow, ‘real world’ activity levels, and predictions of benefit rarely feature. The multidisciplinary Heart Team meeting, now integral to study design, is challenging to deliver in practice. The PCI/CABG trials, and the issues arising from them, provide salutary lessons in the TAVI/SAVR era.
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Ariyaratne TV, Ademi Z, Huq M, Rosenfeldt F, Duffy SJ, Parkinson B, Yap CH, Smith J, Billah B, Yan BP, Brennan AL, Tran L, Reid CM. The Real-World Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Stenting in High-Risk Patients: Propensity Score-Matched Analysis of a Single-Centre Experience. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:661-674. [PMID: 29998450 DOI: 10.1007/s40258-018-0407-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND There are limited economic evaluations comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease (MVCAD) in contemporary, routine clinical practice. OBJECTIVE The aim was to perform a cost-effectiveness analysis comparing CABG and PCI in patients with MVCAD, from the perspective of the Australian public hospital payer, using observational data sources. METHODS Clinical data from the Melbourne Interventional Group (MIG) and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registries were analysed for 1022 CABG (treatment) and 978 PCI (comparator) procedures performed between June 2009 and December 2013. Clinical records were linked to same-hospital admissions and national death index (NDI) data. The incremental cost-effectiveness ratios (ICERs) per major adverse cardiac and cerebrovascular event (MACCE) avoided were evaluated. The propensity score bin bootstrap (PSBB) approach was used to validate base-case results. RESULTS At mean follow-up of 2.7 years, CABG compared with PCI was associated with increased costs and greater all-cause mortality, but a significantly lower rate of MACCE. An ICER of $55,255 (Australian dollars)/MACCE avoided was observed for the overall cohort. The ICER varied across comparisons against bare metal stents (ICER $25,815/MACCE avoided), all drug-eluting stents (DES) ($56,861), second-generation DES ($42,925), and third-generation of DES ($88,535). Moderate-to-low ICERs were apparent for high-risk subgroups, including those with chronic kidney disease ($62,299), diabetes ($42,819), history of myocardial infarction ($30,431), left main coronary artery disease ($38,864), and heart failure ($36,966). CONCLUSIONS At early follow-up, high-risk subgroups had lower ICERs than the overall cohort when CABG was compared with PCI. A personalised, multidisciplinary approach to treatment of patients may enhance cost containment, as well as improving clinical outcomes following revascularisation strategies.
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Affiliation(s)
- Thathya V Ariyaratne
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Molla Huq
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Franklin Rosenfeldt
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Cheng-Hon Yap
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
| | - Julian Smith
- Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, VIC, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Bryan P Yan
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Lavinia Tran
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
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Long term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:671-678. [DOI: 10.1016/j.carrev.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/26/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022]
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Rodríguez-Olivares R, López-Menéndez J, Barca LV, Hycka JM, Hernández-Antolín R, Rodríguez-Roda Stuart J, Zamorano Gómez JL. Identification of candidates for coronary artery bypass grafting admitted with STEMI and Multivessel Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:21-26. [PMID: 29934066 DOI: 10.1016/j.carrev.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal management of patients with multivessel coronary artery disease (MVD) admitted with STEMI is under debate. CABG is rarely performed, even on ideal candidates. A provisional PCI without stent implantation may allow complete surgical revascularization (CSR) in a subset of patient that we sought to identify in this study. METHODS Patients with STEMI from April 2014 to October 2016 were evaluated and those with a TIMI flow <3 in the culprit vessel, and an additional stenosis of >70% in an epicardial vessel or sidebranch >2.5 mm were selected. Epidemiological variables, surgical risk scores and SYNTAX and SYNTAX II scores were analyzed. All the selected patients were discussed in a post hoc heart-team, and predictors of 12-month events were also analyzed. RESULTS Seventy-two (19.0%) accomplished MVD criteria. Mean SYNTAX was 19 ± 13 points and SYNTAX II score recommended CABG in 12 patients (16.7%) and heart-team discussion in 60 (83.3%). All patients were discussed in a post hoc heart-team, which concluded that 21 (29.2%) patients could have been good candidates for CSR. After one year follow-up, SYNTAX II PCI > 40 was found to be the sole independent predictor for 12-month events (OR 12.9 [2.7-62.1], p = 0.001). CONCLUSIONS MVD and STEMI with a SYNTAX II PCI > 40 should be discussed in an ad-hoc heart team, after a provisional revascularization of the culprit vessel, and should be considered for CSR, especially when the RCA is the culprit artery and there is a complex disease in the left coronary artery.
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Affiliation(s)
- Ramón Rodríguez-Olivares
- Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain.
| | - José López-Menéndez
- Department of Cardiac Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Laura Varela Barca
- Department of Cardiac Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | | | - Rosana Hernández-Antolín
- Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain
| | | | - Jose L Zamorano Gómez
- Department of Cardiology, Ramón y Cajal University Hospital, Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain
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Ariyaratne TV, Yap CH, Ademi Z, Rosenfeldt F, Duffy SJ, Billah B, Reid CM. A systematic review of cost-effectiveness of percutaneous coronary intervention vs. surgery for the treatment of multivessel coronary artery disease in the drug-eluting stent era. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 2:261-270. [PMID: 29474722 DOI: 10.1093/ehjqcco/qcw007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Indexed: 11/13/2022]
Abstract
Aims The suitability of percutaneous coronary intervention (PCI), compared with coronary artery bypass grafting (CABG), for patients with complex multivessel coronary artery disease (MVCAD) remains a contentious topic. While the body of evidence regarding the clinical effectiveness of these revascularization strategies is growing, there is limited evidence concerning their long-term cost-effectiveness. We aim to critically appraise the body of literature investigating the cost-effectiveness of CABG compared with PCI using stents, and to assess the quality of the economic evidence available. Methods and results A systematic review was performed across six electronic databases; Medline, Embase, the NHS Economic Evaluation Database, the Database of Abstracts of Reviews of Effects, the health technology assessment database, and the Cochrane Library. All studies comparing economic attractiveness of CABG vs. PCI using bare-metal stents (BMS) or drug-eluting stents (DES) in balanced groups of patients were considered. Sixteen studies were included. These comprised studies of conventional CABG vs. BMS (n = 8), or DES (n = 4); off-pump CABG vs. BMS (n = 2), or DES (n = 1); and minimally invasive direct CABG vs. BMS (n = 2). The majority adopted a healthcare payer perspective (n = 14). The incremental cost-effectiveness ratios (ICERs) reported across studies varied widely according to perspective and time horizon. Favourable lifetime ICERs were reported for CABG in three trials. For patients with left main coronary artery disease, however, DES was reported as the dominant (more effective and cost-saving) strategy in one study. Conclusion Overall, CABG rather than PCI was the favoured cost-effective treatment for complex MVCAD in the long term. While the evidence base for the cost-effectiveness of DES compared with CABG is growing, there is a need for more evaluations adopting a societal perspective, and time horizons of a lifetime or 10 or more years.
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Affiliation(s)
- Thathya V Ariyaratne
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Cheng-Hon Yap
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
| | - Zanfina Ademi
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Frank Rosenfeldt
- Cardiac Surgical Research Unit, Department of Cardiothoracic Surgery,Alfred Hospital, Melbourne, VIC, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, VIC, Australia
| | - Baki Billah
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine (DEPM), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC 3004, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
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Baumann M, Tchicaya A, Lorentz N, Le Bihan E. Life satisfaction and longitudinal changes in physical activity, diabetes and obesity among patients with cardiovascular diseases. BMC Public Health 2017; 17:925. [PMID: 29197375 PMCID: PMC5712077 DOI: 10.1186/s12889-017-4925-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 11/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Patients with cardiovascular disease who underwent coronary angiography at the National Institute of Cardiac Surgery and Cardiological Intervention (INCCI) in Luxembourg were surveyed for cardiovascular risk factors (CVRF) (hypertension, hypercholesterolemia, diabetes, obesity, physical inactivity, tobacco consumption). In 2013/14, their life satisfaction (LS) was also assessed. Our aim was to analyse the relationships between LS on one hand and longitudinal changes in CVRF between 2008/09 and 2013/14 and socioeconomic factors on the other. Methods 1289 patients completed a self-administered questionnaire. Life Satisfaction, originally recorded on a 1 to 10 scale of complete satisfaction was dichotomized into two groups: ≤ 7 and. >7. We then performed logistic multiple regressions. The event on which the probability was modelled, was LS > 7. Data were adjusted on age, sex and income. Longitudinal changes in CVRF were assessed by their presence or absence in 2008/09 and 2013/14 (categories: ‘no-no’; ‘no-yes’; ‘yes-no’; ‘yes-yes’). Results Physical activity in 2008/09 and 2013/14 was associated with a lower LS (OR = 0.469). The same pattern was observed for obesity and physical inactivity: lower LS was related to the presence of these risks (yes-yes; no-yes) in 2013/14 (mean OR for obesity and physical inactivity in 2013/14: 0.587 and 0.485 respectively), whereas their presence or absence in 2008/09 was not related to LS. Finally, patients who suffered from diabetes in 2008 were more likely to experience a decline in LS, particularly if their diabetes was less severe in 2013/14 (OR = 0.462). Conclusions The lowest LS was observed when obesity or physical inactivity was present in 2013/14, newly or otherwise. The same trend was seen in diabetes among patients who had it in 2008/9, but were less severely affected in 2013/14. In secondary prevention, CVD-related upheavals could be minimised if professionals and patients became ‘Partners in Healthcare’ to better adhere to healthy lifestyles, as well as to reduce CVRF, and thereby enhance LS.
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Affiliation(s)
- Michèle Baumann
- Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Belval Campus, L-4366, Esch-sur-Alzette, Luxembourg.
| | - Anastase Tchicaya
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - Nathalie Lorentz
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - Etienne Le Bihan
- Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Belval Campus, L-4366, Esch-sur-Alzette, Luxembourg
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Razzouk L, Feit F, Farkouh ME. Revascularization for Advanced Coronary Artery Disease in Type 2 Diabetic Patients: Choosing Wisely Between PCI and Surgery. Curr Cardiol Rep 2017; 19:37. [PMID: 28374179 DOI: 10.1007/s11886-017-0849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of systemic atherosclerosis and advanced coronary artery disease (CAD). Herein, we review clinical trials comparing surgical to percutaneous revascularization in the context of the unique pathophysiology in this patient population, and seek to answer the question of optimal strategy of revascularization. RECENT FINDINGS Early studies showed a signal towards benefit of surgical revascularization over percutaneous revascularization in this group, but there was a paucity of randomized clinical trials (RCT) to directly support this finding. The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM), a large-scale international RCT, was then undertaken and established the benefit of coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in terms of mortality, myocardial infarction and repeat revascularization; CABG was inferior to PCI with regards to stroke. The quality of life and cost effectiveness also demonstrated a long-term benefit for surgery. The decision as to choice of mode of revascularization in patients with T2DM and advanced CAD depends upon a multitude of factors, including the coronary anatomy, co-morbidities and the patient's surgical risk. These factors influence the recommendation of the cardiovascular team, which should result in a balanced presentation of the short and long-term risks and benefits of either mode of revascularization to the patient and his/her family.
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Affiliation(s)
- Louai Razzouk
- Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, 10016, USA.
| | - Frederick Feit
- Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada.,Heart and Stroke Richard Lewar Centre of Excellence in CV Research, University of Toronto, Toronto, Ontario, Canada
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Carnero-Alcázar M, Villagrán-Medinilla E. Nuestra verdad sobre SYNTAX. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Prasad A, Gersh BJ. Stable Coronary Artery Disease. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Bernard J. Gersh
- Mayo Clinic and Mayo Clinic College of Medicine; Rochester MN USA
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15
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Wang PL, Zhang L, Wang SL, Yang QN, Gao ZY, Du JP, Zhang DW, Fu CG, Gu F, Xu H, Li LZ, Wang CL, Shi DZ. Long-term follow-up of Chinese herbal medicines combined with conventional treatment in patients with acute coronary syndrome after percutaneous coronary intervention: A multicenter randomized controlled trial. Chin J Integr Med 2016; 23:740-746. [PMID: 27778264 DOI: 10.1007/s11655-016-2608-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the prognosis effect of Chinese herbal medicines (CHMs) for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). METHODS A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation (treatment group, 351 cases) or conventional treatment alone (control group, 351 cases) for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12th, 18th, 24th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization (PCI or coronary artery bypass grafting); and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. RESULTS A total of 621 (88.59%) patients completed 35.4±3.8 months follow-up, while 80 (11.41%) patients withdrew from the trial (41 in the treatment group and 39 in the control group). The incidence of primary endpoint was 5.7% (20 patients) in the treatment group versus 10.86% (38 patients) in the control group [relative risk (RR): 0.53; 95% confidence interval (CI): 0.30, 0.88; P=0.013; absolute risk reduction (ARR):-0.052, 95% CI: -0.06, 0.01]. The incidence of secondary endpoint was 5.98% (21 patients) in the treatment group versus 10.28% (36 patients) in control group (RR: 0.58, 95% CI: 0.33, 0.97, P=0.037; ARR: -0.043, 95% CI: 0.06, 0.01). Most of the primary and secondary endpoints were occurred in 18 months (84.50% in the treatment group versus 78.10% in the control group). CONCLUSION CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.
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Affiliation(s)
- Pei-Li Wang
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Lei Zhang
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
| | - Shao-Li Wang
- Department of Gastroenterology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Qiao-Ning Yang
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Zhu-Ye Gao
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jian-Peng Du
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Da-Wu Zhang
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chang-Geng Fu
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Feng Gu
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Hao Xu
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Li-Zhi Li
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Cheng-Long Wang
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Da-Zhuo Shi
- Institute of Cardiovascular Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
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Henderson RA. Cost and efficacy of myocardial revascularization in the drug-eluting stent era: how much for how much? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:225-228. [PMID: 29474721 DOI: 10.1093/ehjqcco/qcw047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Robert A Henderson
- Consultant Cardiologist, Trent Cardiac Centre, Nottingham University Hospitals, City Hospital Campus, Nottingham NG51PB, UK
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17
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Rezende PC, Hueb W. The challenge of treating elderly coronary artery disease patients. J Thorac Dis 2016; 8:1434-6. [PMID: 27500632 DOI: 10.21037/jtd.2016.05.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paulo Cury Rezende
- Department of Atherosclerosis, Heart Institute of the University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Whady Hueb
- Department of Atherosclerosis, Heart Institute of the University of São Paulo, School of Medicine, São Paulo, Brazil
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Herbison P, Wong CK. Has the difference in mortality between percutaneous coronary intervention and coronary artery bypass grafting in people with heart disease and diabetes changed over the years? A systematic review and meta-regression. BMJ Open 2015; 5:e010055. [PMID: 26719324 PMCID: PMC4710812 DOI: 10.1136/bmjopen-2015-010055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the difference in outcome between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), to see if it has changed over the years in diabetics deemed eligible for both treatments; and to contrast the long-term mortality findings with those in non-diabetics. DESIGN Meta-analyses using data from randomised controlled trials found by searches on MEDLINE, EMBASE and the Cochrane Controlled Trials Register, from their inception until March 2015. SETTING Studies had to be randomised controlled trials comparing PCI with CABG. PARTICIPANTS Those taking part in the studies had to have multivessel cardiac or left main artery cardiac disease and be deemed eligible for both treatments. INTERVENTIONS PCI or CABG. PRIMARY AND SECONDARY OUTCOMES The primary outcome was all cause mortality. Secondary outcomes were a composite of mortality, stroke and myocardial infarction; cardiovascular death; and MACCE (Major Adverse Cardiac or Cerebrovascular Event). The longest follow-up was used in the analysis. RESULTS Among 14 studies (4868 diabetics) reported over three decades, meta-regression shows no relationship between the year of publication and the difference in long term all cause mortality between PCI and CABG. CABG has maintained an approximately 30% mortality advantage compared to PCI. The other outcomes used showed the same lack of change over the years. These findings held true among insulin-requiring and non-insulin-requiring diabetics. However, among non-diabetics included in the 14 studies, there was no difference in mortality outcome between PCI and CABG. CONCLUSIONS The difference in outcome between PCI and CABG in diabetics has not narrowed from the beginning-with balloon angioplasty to current PCI-with the second generation of drug eluting stents. In contrast to the non-diabetics, there is a persistent 30% benefit in all cause mortality favouring CABG in diabetics, and this should be a major factor in treatment recommendation.
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Affiliation(s)
- Peter Herbison
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Cheuk-Kit Wong
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Medicine and Therapeutics, Chinese University of Hong Kong Shatin, New Territories, Hong Kong
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Osnabrugge RL, Magnuson EA, Serruys PW, Campos CM, Wang K, van Klaveren D, Farooq V, Abdallah MS, Li H, Vilain KA, Steyerberg EW, Morice MC, Dawkins KD, Mohr FW, Kappetein AP, Cohen DJ. Cost-effectiveness of percutaneous coronary intervention versus bypass surgery from a Dutch perspective. Heart 2015; 101:1980-8. [PMID: 26552756 DOI: 10.1136/heartjnl-2015-307578] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 10/05/2015] [Indexed: 11/04/2022] Open
Abstract
AIMS Recent cost-effectiveness analyses of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) have been limited by a short time horizon or were restricted to the US healthcare perspective. We, therefore, used individual patient-level data from the SYNTAX trial to evaluate the cost-effectiveness of PCI versus CABG from a European (Dutch) perspective. METHODS AND RESULTS Between 2005 and 2007, 1800 patients with three-vessel or left main coronary artery disease were randomised to either CABG (n=897) or PCI with drug-eluting stents (DES; n=903). Costs were estimated for all patients based on observed healthcare resource usage over 5 years of follow-up. Health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on Dutch life-tables was used to extrapolate the 5-year in-trial data to a lifetime horizon. Although initial procedural costs were lower for CABG, total initial hospitalisation costs per patient were higher (€17 506 vs €14 037, p<0.001). PCI was more costly during the next 5 years of follow-up, due to more frequent hospitalisations, repeat revascularisation procedures and higher medication costs. Nevertheless, total 5-year costs remained €2465/patient higher with CABG. When the in-trial results were extrapolated to a lifetime horizon, CABG was projected to be economically attractive relative to DES-PCI, with gains in both life expectancy and quality-adjusted life expectancy. The incremental cost-effectiveness ratio (ICER) (€5390/quality-adjusted life year (QALY) gained) was favourable and remained <€80 000/QALY in >90% of the bootstrap replicates. Outcomes were similar when incorporating the prognostic impact of non-fatal myocardial infarction and stroke, as well as across a broad range of assumptions regarding the effect of CABG on post-trial survival and costs. However, DES-PCI was economically dominant compared with CABG in patients with a SYNTAX Score ≤22 or in those with left main disease. In patients for whom the SYNTAX Score II favoured PCI based on lower predicted 4-year mortality, PCI was also economically dominant, whereas in those patients for whom the SYNTAX Score II favoured surgery, CABG was highly economically attractive (ICER range, €2967 to €3737/QALY gained). CONCLUSIONS For the broad population with three-vessel or left main disease who are candidates for either CABG or PCI, we found that CABG is a clinically and economically attractive revascularisation strategy compared with DES-PCI from a Dutch healthcare perspective. The cost-effectiveness of CABG versus PCI differed according to several anatomic factors, however. The newly developed SYNTAX Score II provides enhanced prognostic discrimination in this population, and may be a useful tool to guide resource allocation as well. TRIAL REGISTRATION NUMBER Clinical trial unique identifier: NCT00114972 (http://www.clinical-trials.gov).
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Affiliation(s)
- Ruben L Osnabrugge
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA Department of Cardio-Thoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Elizabeth A Magnuson
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Patrick W Serruys
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Carlos M Campos
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Kaijun Wang
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - David van Klaveren
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Vasim Farooq
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mouin S Abdallah
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Haiyan Li
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Katherine A Vilain
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marie-Claude Morice
- Department of Interventional Cardiology, Institut Jacques Cartier, Massy, France
| | | | - Friedrich W Mohr
- Department of Cardiac Surgery, Herzzentrum Universität Leipzig, Leipzig, Germany
| | - A Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - David J Cohen
- Department of Cardiovascular Research, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Chandwani P, Prajapati J, Porwal S, Khambhati B, Thakkar A. Evaluation of clinical outcomes in patients undergoing dual vessel percutaneous coronary intervention using sirolimus-eluting coronary stent system in India. J Clin Diagn Res 2015; 9:OC05-9. [PMID: 25859478 DOI: 10.7860/jcdr/2015/10766.5525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/26/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Coronary artery disease is the most common catastrophic disease in India. The safety and effectiveness of dual vessel sirolimus-eluting stent (SES) implantation (used as an intervention in CAD) is currently unknown in Indian population. The purpose of this study was to investigate one year clinical outcomes of patients with dual vessel coronary artery disease after implantation of the Supralimus-Core SES, in a "real-world" setting. MATERIALS AND METHODS We evaluated 60 patients between April-2011 and August-2012, who underwent dual vessel percutaneous coronary intervention (PCI) with the Supralimus-Core SES implantation at the same index procedure. Dual vessels were defined as involvement of two major epicardial vessels (right, left anterior descending, circumflex, or left main coronary arteries) or one major epicardial vessel and a branch (≥2.5 mm in diameter) originating from another major epicardial vessel. The primary endpoint was target lesion failure (TLF) defined as the composite of cardiac death, myocardial infarction (MI), and clinically-driven target lesion revascularization (TLR) at one year. Secondary endpoint included combined (definite, probable and possible) stent thrombosis (ST). RESULTS A total of 120 lesions were treated in 60 enrolled patients (mean age 56.0±9.2 y; 80.0% male) with average stent length of 23.1±8.5 mm. Among 60 patients, diabetes, hypertension and hypercholesterolemia were present in 15 (25.0%), 22 (36.7%) and 25 (41.7%) patients respectively. Indications for PCI were unstable angina in 30 (50.0%) patients and stable angina in 11 (18.3%) patients. Overall, 40 (33.3%) lesions were classified as complex (American College of Cardiology/American Heart Association type B2/C). The cumulative TLF rate was 5.0% (n=3) at one year. Cardiac death, MI and clinically-driven TLR occurred in 1 (1.7%), 0 (0%) and 2 (3.3%) patients, respectively at one year follow-up. The Kaplan-Meier curve of the freedom from overall events at one year was 95.0%. According to the Academic Research Consortium definition, there were no events of stent thrombosis during one year. CONCLUSION Our study shows that, dual vessel Supralimus-Core SES implantation allows safe and effective treatment with low rates of TLF at one year follow-up in Indian population.
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Affiliation(s)
- Prakash Chandwani
- Director, Department of Cardiology, Heart and General Hospital , 7, Vivekanand Marg, C-Scheme, Jaipur, India
| | - Jayesh Prajapati
- Senior Interventional Cardiologist, Department of Cardiology, Apollo Hospitals International Limited , Gandhinagar, Gujarat, India.
| | - Sanjay Porwal
- Associate Professor, Department of Cardiology, KLEs Dr. Prabhakar Kore Hospital & Medical Research Centre , Belgaum, Karnataka, India
| | - Bhavesh Khambhati
- Senior Clinical Research Associate, Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd , Surat, Gujarat, India
| | - Ashok Thakkar
- Senior Manager, Clinical Research and Medical Writing, Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd , Surat, Gujarat, India
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Dörr R, Stumpf J, Dalibor J, Simonis G, Spitzer SG. [Percutaneous coronary intervention versus bypass surgery in patients with diabetes and multivessel coronary disease. Coronary revascularization after FREEDOM]. Herz 2015; 39:331-42. [PMID: 24740094 DOI: 10.1007/s00059-014-4089-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons.
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Affiliation(s)
- R Dörr
- Praxisklinik Herz und Gefäße, Forststr. 3, 01099, Dresden, Deutschland,
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Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Smit Y, Vlayen J, Koppenaal H, Eefting F, Kappetein AP, Mariani MA. Percutaneous coronary invervention versus coronary artery bypass grafting: a meta-analysis. J Thorac Cardiovasc Surg 2014; 149:831-8.e1-13. [PMID: 25467373 DOI: 10.1016/j.jtcvs.2014.10.112] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/17/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with coronary artery disease. METHODS MEDLINE, Embase, and Cochrane Central were searched, and randomized controlled trials were included. Outcomes were assessed at maximum available follow-up. RESULTS This meta-analysis includes 31 trials with 15,004 patients. As regards death, more patients died after PCI compared with CABG across all types of patients (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0-1.3; P = .05) as well as in patients with multivessel disease (OR, 1.2; 95% CI, 1.0-1.4; P = .02) or diabetes (OR, 1.6; 95% CI, 1.2-2.1; P < .01). Myocardial infarction occurred as frequently after PCI (OR, 1.2; 95% CI, 0.9-1.5; P = .28). Repeat revascularization was more common after PCI (OR, 4.5; 95% CI, 3.5-5.8; P < .01), with a progressive decline in ORs from the pre-stent era (OR, 7.0; 95% CI, 5.1-9.7; P < .01), to the bare metal stent era (OR, 4.5; 95% CI, 3.6-5.5; P < .01), and to the drug-eluting stent era (OR, 2.5; 95% CI, 1.8-3.4; P < .01). Stroke was more common after CABG (OR, 0.7; 95% CI, 0.5-0.9; P = .01). CONCLUSIONS Compared with PCI, CABG had a lower risk of death in multivessel disease or diabetes patients eligible for either intervention, a lower risk of repeat revascularization, but a higher risk of stroke.
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Affiliation(s)
- Yolba Smit
- Independent Researcher, Leuth, The Netherlands
| | | | | | - Frank Eefting
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Caruba T, Katsahian S, Schramm C, Charles Nelson A, Durieux P, Bégué D, Juillière Y, Dubourg O, Danchin N, Sabatier B. Treatment for stable coronary artery disease: a network meta-analysis of cost-effectiveness studies. PLoS One 2014; 9:e98371. [PMID: 24896266 PMCID: PMC4045726 DOI: 10.1371/journal.pone.0098371] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/01/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction and Objectives Numerous studies have assessed cost-effectiveness of different treatment modalities for stable angina. Direct comparisons, however, are uncommon. We therefore set out to compare the efficacy and mean cost per patient after 1 and 3 years of follow-up, of the following treatments as assessed in randomized controlled trials (RCT): medical therapy (MT), percutaneous coronary intervention (PCI) without stent (PTCA), with bare-metal stent (BMS), with drug-eluting stent (DES), and elective coronary artery bypass graft (CABG). Methods RCT comparing at least two of the five treatments and reporting clinical and cost data were identified by a systematic search. Clinical end-points were mortality and myocardial infarction (MI). The costs described in the different trials were standardized and expressed in US $ 2008, based on purchasing power parity. A network meta-analysis was used to compare costs. Results Fifteen RCT were selected. Mortality and MI rates were similar in the five treatment groups both for 1-year and 3-year follow-up. Weighted cost per patient however differed markedly for the five treatment modalities, at both one year and three years (P<0.0001). MT was the least expensive treatment modality: US $3069 and 13 864 after one and three years of follow-up, while CABG was the most costly: US $27 003 and 28 670 after one and three years. PCI, whether with plain balloon, BMS or DES came in between, but was closer to the costs of CABG. Conclusions Appreciable savings in health expenditures can be achieved by using MT in the management of patients with stable angina.
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Affiliation(s)
- Thibaut Caruba
- Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- * E-mail:
| | - Sandrine Katsahian
- URC Hôpital Henri Mondor, APHP, Créteil, France
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
| | | | | | - Pierre Durieux
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
- Département de Santé Publique et Informatique, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Dominique Bégué
- Faculté de Pharmacie, Université René Descartes, Paris, France
| | - Yves Juillière
- Cardiologie, Institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, Nancy, France
| | - Olivier Dubourg
- Cardiologie, Hôpital Ambroise Paré, APHP, Boulogne Billancourt, France
- Université de Versailles-Saint Quentin, Montigny-Le-Bretonneux, France
| | - Nicolas Danchin
- Cardiologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Faculté de Médecine, Université René Descartes, Paris, France
| | - Brigitte Sabatier
- Pharmacie, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Equipe 22, Centre de Recherche des Cordeliers, UMRS 762 INSERM, Paris, France
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Krenn L, Kopp C, Glogar D, Lang IM, Delle-Karth G, Neunteufl T, Kreiner G, Kaider A, Bergler-Klein J, Khorsand A, Nikfardjam M, Laufer G, Maurer G, Gyöngyösi M. Cost-effectiveness of percutaneous coronary intervention with drug-eluting stents in patients with multivessel coronary artery disease compared to coronary artery bypass surgery five-years after intervention. Catheter Cardiovasc Interv 2014; 84:1029-39. [PMID: 24403120 PMCID: PMC4262069 DOI: 10.1002/ccd.25397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/23/2013] [Indexed: 11/30/2022]
Abstract
Objectives Cost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and coronary artery bypass surgery (CABG) was analyzed in patients with multivessel coronary artery disease over a 5-year follow-up. Background DES implantation reducing revascularization rate and associated costs might be attractive for health economics as compared to CABG. Methods Consecutive patients with multivessel DES-PCI (n = 114, 3.3 ± 1.2 DES/patient) or CABG (n = 85, 2.7 ± 0.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularization, and stroke. Results Despite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 €/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 € between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5-year follow-up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank P = 0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank P = 0.359) was observed in PCI as compared to CABG. ICER indicated 45615 € or 126683 € to prevent one MACCE or AMI/death/stroke if CABG is performed. Conclusions Cost-effectiveness analysis of DES-PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa Krenn
- Department of Cardiology, Medical University of Vienna, Wahringer Gürtel 18-20, A-1090 Vienna, Austria
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Osnabrugge RLJ, Head SJ, Bogers AJJC, Kappetein AP. Multivessel coronary artery disease: quantifying how recent trials should influence clinical practice. Expert Rev Cardiovasc Ther 2014; 11:903-18. [DOI: 10.1586/14779072.2013.811977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Góngora E, Sundt TM. Role of surgical revascularization in diabetic patients with coronary artery disease. Expert Rev Cardiovasc Ther 2014; 3:249-60. [PMID: 15853599 DOI: 10.1586/14779072.3.2.249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Diabetes is a well-known risk factor for morbidity and mortality associated with coronary artery disease. Currently, diabetics represent approximately a quarter of patients requiring coronary revascularization in the USA. The purpose of this article is to review and analyze the available data in surgical revascularization of diabetic patients with coronary artery disease. The review will also examine new developments in myocardial revascularization and assess their probable impact on the long-term outcome of diabetic patients.
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Affiliation(s)
- Enrique Góngora
- Division of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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28
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Reffelmann T, Kloner RA. Ranolazine: an anti-anginal drug with further therapeutic potential. Expert Rev Cardiovasc Ther 2014; 8:319-29. [DOI: 10.1586/erc.09.178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Refining the role of antiplatelet therapy in medically managed patients with acute coronary syndrome. Am J Cardiol 2013; 111:439-44. [PMID: 23168289 DOI: 10.1016/j.amjcard.2012.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/09/2012] [Accepted: 10/09/2012] [Indexed: 01/20/2023]
Abstract
Dual-antiplatelet therapy with aspirin plus a P2Y(12) receptor inhibitor is recommended for use as first-line therapy in patients with acute coronary syndromes (ACS) who undergo high-risk percutaneous coronary intervention. However, revascularization may not be a beneficial option for some subgroups of patients with ACS. This includes a broad spectrum of lower risk patients as well as high-risk patients with numerous previous revascularizations and those who are at high risk for complications, such as those with complex coronary anatomy and co-morbidities such as diabetes mellitus, chronic kidney disease, or advanced age and frailty. For such patients, there remains an unmet need for evaluation of alternatives to the currently recommended treatment options. Notably, there is a paucity of prospective data regarding management approaches to medically managed patients with ACS. Thus, this group of medically managed patients with ACS would benefit from inclusion in clinical trials investigating therapeutic options for patients not scheduled to undergo invasive procedures, such as those who are targeted for pharmacologic management only. In conclusion, in this review, the investigators revisit data from clinical studies of dual-antiplatelet therapy in ACS to highlight areas of unmet need in antiplatelet therapy in patients with ACS and to examine the use of newer agents in subgroups, such as medically managed patients with ACS, that would potentially benefit from more potent platelet inhibition after ACS.
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Drug-eluting stents in multivessel coronary artery disease: cost effectiveness and clinical outcomes. Adv Pharmacol Sci 2013; 2012:679013. [PMID: 23346105 PMCID: PMC3533590 DOI: 10.1155/2012/679013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 11/07/2012] [Accepted: 11/25/2012] [Indexed: 11/29/2022] Open
Abstract
Multivessel coronary artery disease is more often treated either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) with stenting. The advent of drug-eluting stent (DES) has changed the revascularization strategy, and caused an increase in the use of DES in multivessel disease (MVD), with reduced rate of repeat revascularization compared to conventional bare metal stent. The comparative studies of DES-PCI over CABG have shown comparable safety; however, the rate of major adverse cerebrovascular and cardiac events and repeat revascularization was significantly higher with DES-PCI at long term. In diabetic patients with MVD, concern of repeat revascularization with DES-PCI is persistent. More recent, one-year economic outcomes have reported that the CABG is favored among patients with high angiographic complexity. The higher rate of repeat revascularization with DES-PCI in MVD would lead to increased economic burden on patient at long term besides bearing high cost of DES. In diabetic MVD patients, CABG is associated with having better clinical outcomes and being more cost-effective approach when compared to DES-PCI at long term.
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Rezende PC, Hueb W, Garzillo CL, Lima EG, Hueb AC, Ramires JAF, Kalil Filho R. Ten-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial. J Thorac Cardiovasc Surg 2012; 146:1105-12. [PMID: 22944095 DOI: 10.1016/j.jtcvs.2012.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/19/2012] [Accepted: 08/01/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options. METHODS Patients were separated according to age: 65 years or more (n = 200) and less than 65 years (n = 411). All patients were followed for 10 years. The rates of overall mortality, acute myocardial infarction, and new revascularizations were analyzed. RESULTS Of 200 patients aged 65 years or more, 68 were randomized to medical therapy, 68 were randomized to percutaneous coronary intervention, and 64 were randomized to coronary artery bypass grafting. At 10 years, overall survival was 63% (medical therapy), 69% (percutaneous coronary intervention), and 66% (coronary artery bypass grafting) (P = .93). The survival free of combined events was 43% (medical therapy), 38% (percutaneous coronary intervention ), and 66% (coronary artery bypass grafting) (P = .007). The survival free of myocardial infarction was 82% (medical therapy), 77% (percutaneous coronary intervention), and 90% (coronary artery bypass grafting) (P = .17), and survival free of new revascularizations was 59% (medical therapy), 58% (percutaneous coronary intervention ), and 91% (coronary artery bypass grafting) (P = .0003). When the 2 age groups were compared, survival free of myocardial infarction for patients treated by percutaneous coronary intervention was 77% (older patients) and 92% (younger patients) (P = .004). CONCLUSIONS In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.
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Affiliation(s)
- Paulo Cury Rezende
- Department of Atherosclerosis, Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil
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Zhang F, Yang Y, Hu D, Lei H, Wang Y. Percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in the treatment of diabetic patients with multi-vessel coronary disease: a meta-analysis. Diabetes Res Clin Pract 2012; 97:178-84. [PMID: 22513345 DOI: 10.1016/j.diabres.2012.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 03/18/2012] [Accepted: 03/20/2012] [Indexed: 11/22/2022]
Abstract
Diabetes is prevalent in patients with coronary artery disease. In diabetic patients with multi-vessel coronary disease, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are widely used for revascularization. We aimed to compare the effectiveness and safety of PCI and CABG in these patients. Nine randomized controlled trials were identified in which a total of 1047 diabetic patients were randomly assigned to PCI and 1054 to CABG. Results showed that five-year mortality was significantly higher in diabetic patients after PCI than after CABG (risk difference (RD) of 7%; P<0.001); repeated revascularization was more common after PCI than after CABG (one-year RD of 13%; P<0.001); major adverse cardiac and cerebrovascular events were also more frequent after PCI (one-year RD of 12%; P<0.001); however, the cerebrovascular accident rate was lower in the PCI group than the CABG group (one-year RD of -2%; P=0.004). Conclusively, in diabetic patients with multi-vessel coronary disease, CABG was not only more effective than PCI in reducing mortality but also led to fewer repeated revascularizations and fewer major adverse cardiac and cerebrovascular events. Despite these benefits, CABG did put diabetic patients at higher risk for cerebrovascular accident than PCI.
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Affiliation(s)
- Fan Zhang
- School of Public Health and Health Management, Chongqing Medical University, Chongqing, China
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Taşçı C, Özçelik N. An Overview on Coronary Heart Disease (A Comparative Evaluation of Turkey and Europe) and Cost-effectiveness of Diagnostic Strategies. Mol Imaging Radionucl Ther 2011; 20:75-93. [PMID: 23487016 PMCID: PMC3590955 DOI: 10.4274/mirt.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/14/2011] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Coronary heart disease (CHD) is the leading cause of death for men and women in Turkey as it is in Europe and US. The prevalence of the disease is 3.8% in Turkey and 200,000 patients are added to the pool of CHD annually Because of genetic predisposition and high proportions of physical inactivity, smoking habit, and obesity, CHD is encountered in earlier ages in our country So, the economic burden of the disease is expected to be relatively high, but the amount of health expenditure is not always parallel to the prevalence of a disease in the community. This article was written to overview CHD statistics to make a comparison between Turkey and some European countries and to investigate the value of myocardial perfusion scan (MPS) as a gatekeeper in diagnosing CHD before invasive coronary angiography (ICA). The consequences were evaluated for Turkey In diagnosis; noninvasive testing gains importance in connection with the new approaches in treatment strategies, because a direct ICA strategy results in higher rates of revascularization without improvement in clinical outcomes. A "gatekeeper" is needed to select the patients who are not required to undergo angiography. MPS with its proved power in diagnosis and predicting prognosis, provides a cost-effective solution, and is accepted in some extensive analyses as a "gatekeeper" particularly in intermediate and high risk patients and in patients with known CHD. In conclusion, MPS may provide an optimal solution better than the ongoing situation in Turkey as well, when it is approved as a "gatekeeper in an algorithm before ICA. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Cengiz Taşçı
- Gama Medical Center, Derpartment of Nuclear Medicine, Gaziantep, Turkey
| | - Nihat Özçelik
- Gama Medical Center, Derpartment of Nuclear Medicine, Gaziantep, Turkey
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Cohen DJ, Lavelle TA, Van Hout B, Li H, Lei Y, Robertus K, Pinto D, Magnuson EA, Mcgarry TF, Lucas SK, Horwitz PA, Henry CA, Serruys PW, Mohr FW, Kappetein AP. Economic outcomes of percutaneous coronary intervention with drug-eluting stents versus bypass surgery for patients with left main or three-vessel coronary artery disease: one-year results from the SYNTAX trial. Catheter Cardiovasc Interv 2011; 79:198-209. [PMID: 21542113 DOI: 10.1002/ccd.23147] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/19/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of alternative approaches to revascularization for patients with three-vessel or left main coronary artery disease (CAD). BACKGROUND Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery (CABG) in multivessel CAD are similar to those for percutaneous coronary intervention (PCI). The impact of drug-eluting stents (DES) on these results is unknown. METHODS The SYNTAX trial randomized 1,800 patients with left main or three-vessel CAD to either CABG (n = 897) or PCI using paclitaxel-eluting stents (n = 903). Resource utilization data were collected prospectively for all patients, and cumulative 1-year costs were assessed from the perspective of the U.S. healthcare system. RESULTS Total costs for the initial hospitalization were $5,693/patient higher with CABG, whereas follow-up costs were $2,282/patient higher with PCI due mainly to more frequent revascularization procedures and higher outpatient medication costs. Total 1-year costs were thus $3,590/patient higher with CABG, while quality-adjusted life expectancy was slightly higher with PCI. Although PCI was an economically dominant strategy for the overall population, cost-effectiveness varied considerably according to angiographic complexity. For patients with high angiographic complexity (SYNTAX score > 32), total 1-year costs were similar for CABG and PCI, and the incremental cost-effectiveness ratio for CABG was $43,486 per quality-adjusted life-year gained. CONCLUSIONS Among patients with three-vessel or left main CAD, PCI is an economically attractive strategy over the first year for patients with low and moderate angiographic complexity, while CABG is favored among patients with high angiographic complexity.
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Affiliation(s)
- David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri 64111, USA.
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Abstract
Despite a substantial number of patients with end-stage renal disease who have coronary artery disease, the comparative effectiveness of revascularization procedures such as coronary artery bypass grafting and percutaneous coronary intervention remain unclear. Innovations in the field of coronary artery revascularization and concomitant changes in the standard of practice have improved outcomes in general. However, meaningful clinical decision-making remains difficult because it requires clinicians to extrapolate evidence derived from studies in the general population to patients with kidney disease for whom there is limited information from intervention trials. In non-randomized studies, this high-risk population for cardiovascular morbidity and mortality appear to derive substantial benefits from coronary revascularization. However, specific treatment decisions are often made based upon individual circumstances and contexts that are not well captured in these studies. This article reviews the available evidence, and its limitations, for deciding between various revascularization strategies for patients with end-stage renal disease. Several considerations that arise while making such decisions are discussed.
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Affiliation(s)
- John K Roberts
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Inhibition of human in-stent restenosis: a molecular view. Curr Opin Pharmacol 2011; 11:372-7. [DOI: 10.1016/j.coph.2011.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 03/21/2011] [Indexed: 12/20/2022]
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Onuma Y, Wykrzykowska JJ, Garg S, Vranckx P, Serruys PW. 5-Year follow-up of coronary revascularization in diabetic patients with multivessel coronary artery disease: insights from ARTS (arterial revascularization therapy study)-II and ARTS-I trials. JACC Cardiovasc Interv 2011; 4:317-23. [PMID: 21435610 DOI: 10.1016/j.jcin.2010.12.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 11/29/2010] [Accepted: 12/09/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We compared the 5-year outcomes of diabetic patients with multivessel disease treated with sirolimus-eluting stents (SES), bare-metal stents (BMS), and coronary artery bypass graft surgery (CABG) enrolled in the ARTS (Arterial Revascularization Therapy Study) I and II studies. BACKGROUND Diabetes is an established risk factor for major adverse cardiac events after revascularization. Recent trials suggest that revascularization with drug-eluting stents has equivalent safety to CABG up to 2 years. METHODS The ARTS I and II studies included 367 diabetic patients (SES: 159, CABG: 96, and BMS: 112) compared with respect to 5-year clinical outcomes. RESULTS The rate of major adverse cardiovascular and cerebrovascular events was significantly higher in patients treated with BMS (BMS 53.6% vs. CABG 23.4% vs. SES 40.5%; log-rank, p < 0.01 for SES vs. BMS and SES vs. CABG). There was no significant difference in mortality among all 3 groups. There was, however, a statistically significant difference in the myocardial infarction rate between BMS and CABG arms (BMS 11.0%, CABG 5.2%, SES 4.8%, p = 0.04 for SES vs. BMS and p = 0.76 for SES vs. CABG). The rate of repeat revascularization was significantly lower in patients treated with CABG compared with SES (SES 33.2% vs. CABG 10.7%, p < 0.001). Revascularization rate of patients treated with SES at 5 years approached that of patients treated with BMS although remained significantly lower. This "catch-up" phenomenon was not apparent in the nondiabetic population. CONCLUSIONS At 5-year follow-up, CABG has comparable safety and superior efficacy compared with BMS and SES in the treatment of diabetic patients with multivessel disease.
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Affiliation(s)
- Yoshinobu Onuma
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Zidar JP. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57:e215-367. [PMID: 21545940 DOI: 10.1016/j.jacc.2011.02.011] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Federspiel JJ, Stearns SC, van Domburg RT, Sheridan BC, Lund JL, Serruys PW. Risk-benefit trade-offs in revascularisation choices. EUROINTERVENTION 2011; 6:936-41. [PMID: 21330240 DOI: 10.4244/eijv6i8a163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS When patients choose percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG), they accept an increased long-term risk of repeat revascularisation in exchange for short-term morbidity benefits. This paper quantifies the risk-benefit trade-off faced by patients with multiple vessel coronary artery disease. METHODS AND RESULTS Data from the Arterial Revascularisation Therapies Study are used to generate risk-benefit acceptability curves for PCI versus CABG. Risks are measured by the long-term likelihood of repeat revascularisation while benefits are measured by short-term reductions in pain or improvements in health-related quality of life (HRQL). PCI patients faced a risk of 0.81 additional revascularisation events over three years in exchange for being pain-free at one month. A patient would need to be willing to tolerate a risk of 1.06 additional revascularisation events at three years, in exchange for being pain free at one month to be 95% confident that choosing PCI over CABG is risk-effective for him/her. CONCLUSIONS The risk-benefit framework outlined in this study provides information to enable physicians to help their patients weigh directly each procedure's risks and benefits. While trade-offs are typically measured in quality-adjusted life years, using pain reduction to reflect benefits may provide a more tangible framework for patients.
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Affiliation(s)
- Jerome J Federspiel
- School of Medicine, Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA
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Ouhoummane N, Abdous B, Louchini R, Rochette L, Poirier P. Trends in postacute myocardial infarction management and mortality in patients with diabetes. A population-based study from 1995 to 2001. Can J Cardiol 2011; 26:523-31. [PMID: 21165361 DOI: 10.1016/s0828-282x(10)70465-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To compare trends in coronary revascularization use and case fatality rate (CFR) following acute myocardial infarction in patients with and without diabetes. METHODS A retrospective study of 77,552 patients, 20 years of age or older (25% with diabetes), who were hospitalized for a first acute myocardial infarction in the province of Quebec between April 1995 and December 2001 was conducted. Administrative databases were used to identify patients and assess outcomes. RESULTS Compared with patients without diabetes, patients with diabetes underwent more coronary artery bypass graft (CABG) surgeries (11.1% versus 8.3%; P<0.0001) but fewer percutaneous coronary interventions (17.1% versus 20.2%; P<0.0001). The use of percutaneous coronary intervention increased substantially over time in both populations, driven mainly by an increase during the index admission (20.6% versus 16.6% per year; P=0.1144 in patients with and without diabetes, respectively). The use of CABG during the index admission increased markedly among patients with diabetes compared with those without (10.3% versus 5.3% per year; P=0.0072); however, at one-year following discharge, CABG use remained stable in patients with diabetes and fell in those without (-0.7% versus -5.3% per year; P=0.2046). Concomitantly, patients with diabetes presented a similar decline in CFR compared with patients without diabetes. The decline was more pronounced during the index admission (-5.0% versus -4.1% per year; P=0.282) than at one-year following discharge (-2.5% versus -2.5% per year; P=0.629) in patients with and without diabetes, respectively. However, fatal outcome remained higher in patients with diabetes than without, with an adjusted RR of 1.21 (95% CI 1.18 to 1.24) at one-year follow-up. CONCLUSION Overall, coronary revascularization use and CFR improved over time in patients with diabetes. Nevertheless, the mortality rate in patients with diabetes remains higher than in patients without diabetes, indicating that additional progress is required to improve the poorer prognosis in this population.
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Affiliation(s)
- Najwa Ouhoummane
- National Public Health Institute of Quebec, Laval University, Canada
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Prasad A, Gersh BJ. Stable Angina. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 123:e426-579. [PMID: 21444888 DOI: 10.1161/cir.0b013e318212bb8b] [Citation(s) in RCA: 349] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Legrand V, Garg S, Serruys P, Virtanen K, Szurawitzki G, Voudris V, Fontanelli A, Endersen K, Kranjec I, Rademaker T, Stefanidis C, Wittebols K. Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II). EUROINTERVENTION 2011; 6:838-45. [DOI: 10.4244/eijv6i7a144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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44
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Magro M, Garg S, Serruys PW. Revascularization treatment of stable coronary artery disease. Expert Opin Pharmacother 2011; 12:195-212. [DOI: 10.1517/14656566.2010.517522] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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45
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Tarantini G, Lanzellotti D. Three-vessel coronary disease in diabetics: personalized versus evidence-based revascularization strategy. Future Cardiol 2010; 6:797-809. [DOI: 10.2217/fca.10.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A steady increase in the number of diabetic patients undergoing coronary revascularization has been recorded in recent years. The causes for this rise are found predominantly in the general demographic development of western industrialized nations, the epidemic progress and wide-spread of diabetes mellitus and changes in assignment behavior. In this article, the specific risk profile of diabetic coronary patients with three-vessel disease in percutaneous or surgical revascularization and tried and tested treatment concepts for this particularly challenging group of patients, with reference to the most recent study results will be presented. Particularly, the peculiarities of coronary heart disease in diabetic patients, the choice of revascularization method, different operative strategies for diabetic patients with coronary heart disease, and challenges faced during follow-up are discussed.
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Affiliation(s)
| | - Davide Lanzellotti
- Department of Cardiac, Thoracic & Vascular Sciences, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy
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46
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Dörr R. [Bypass surgery versus percutaneous coronary intervention in patients with diabetes mellitus]. Herz 2010; 35:182-90. [PMID: 20467930 DOI: 10.1007/s00059-010-3342-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
At present, in patients with diabetes mellitus and coronary multivessel disease no fixed general recommendation can be given in favor or to the disadvantage of surgical revascularization or in favor or to the disadvantage of percutaneous coronary intervention (PCI). In cases with an evidence-based indication for coronary revascularization because of clinical symptoms and/or proven ischemia, both therapeutic alternatives of bypass surgery or PCI are electable. The decision, which method of revascularization to prefer, must be based on close analyses of individual risk profile, individual comorbidity, and individual coronary morphology. With correct indication, both therapeutic methods are equivalent regarding the prognostically important combined endpoint of death, nonfatal myocardial infarction, and stroke. For PCI, however, there is a higher probability of restenosis depending on the complexity of lesion morphology, requiring more often repeat interventions or revascularizations. Before deciding in subfavor of or against a surgical or nonsurgical revascularization procedure, the complexity of the coronary artery disease should be analyzed, for example using the SYNTAX Score. In patients with SYNTAX Scores > or = 33 and no contraindications to bypass surgery, a surgical revascularization should be preferred. In the intermediate group with SYNTAX Scores between 23 und 32, the advantages and disadvantages of bypass surgery or PCI, for instance, the increased probability of restenosis with a higher necessity of repeat revascularizations after PCI, should be extensively discussed with the patient. In patients with SYNTAX Scores between 0 and 22, the nonsurgical, interventional therapy using drug-eluting stents (DES) can be recommended as an equivalent alternative to bypass surgery. In meta-analyses of randomized controlled trials and meta-analyses of large registries with PCI in patients with diabetes mellitus, clear advantages of DES in comparison with bare-metal stents (BMS) could be shown. Especially for patients with diabetes mellitus, there is still no clear evidence in favor of or against a special DES type or in favor of or against a special stent covering. Further sufficiently powered randomized controlled trials with hard clinical endpoints comparing bypass surgery with PCI (e.g., FREEDOM trial) and comparing different types of DES in patients with diabetes mellitus and clear PCI indications must be awaited, before further recommendations can be given.
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Affiliation(s)
- Rolf Dörr
- Praxisklinik Herz und Gefässe, Dresden, Germany.
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Serruys PW, Onuma Y, Garg S, Vranckx P, De Bruyne B, Morice MC, Colombo A, Macaya C, Richardt G, Fajadet J, Hamm C, Schuijer M, Rademaker T, Wittebols K, Stoll HP. 5-Year Clinical Outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the Sirolimus-Eluting Stent in the Treatment of Patients With Multivessel De Novo Coronary Artery Lesions. J Am Coll Cardiol 2010; 55:1093-101. [PMID: 20171036 DOI: 10.1016/j.jacc.2009.11.049] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/11/2009] [Accepted: 11/30/2009] [Indexed: 11/16/2022]
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48
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Remak E, Manson S, Hutton J, Brasseur P, Olivier E, Gershlick A. Cost-effectiveness of the Endeavor stent in de novo native coronary artery lesions updated with contemporary data. EUROINTERVENTION 2010; 5:826-32. [DOI: 10.4244/eijv5i7a138] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dyer MTD, Goldsmith KA, Sharples LS, Buxton MJ. A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 2010; 8:13. [PMID: 20109189 PMCID: PMC2824714 DOI: 10.1186/1477-7525-8-13] [Citation(s) in RCA: 278] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 01/28/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. METHODS A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. RESULTS Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. CONCLUSIONS The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.
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Affiliation(s)
- Matthew TD Dyer
- Health Economics Research Group, Brunel University, Uxbridge, UK
- National Collaborating Centre for Mental Health, The Royal College of Psychiatrists, London, UK
| | - Kimberley A Goldsmith
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Linda S Sharples
- Papworth Hospital NHS Trust, Cambridge UK
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK
| | - Martin J Buxton
- Health Economics Research Group, Brunel University, Uxbridge, UK
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50
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Gyöngyösi M, Christ G, Lang I, Kreiner G, Sochor H, Probst P, Neunteufl T, Badr-Eslam R, Winkler S, Nyolczas N, Posa A, Leisch F, Karnik R, Siostrzonek P, Harb S, Heigert M, Zenker G, Benzer W, Bonner G, Kaider A, Glogar D. 2-Year Results of the AUTAX (Austrian Multivessel TAXUS-Stent) Registry. JACC Cardiovasc Interv 2009; 2:718-27. [DOI: 10.1016/j.jcin.2009.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 05/20/2009] [Accepted: 05/29/2009] [Indexed: 10/20/2022]
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