Risk-benefit trade-offs in revascularisation choices.
Journal Article (Journal Article)
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.
Full Text
Duke Authors
Cited Authors
- Federspiel, JJ; Stearns, SC; van Domburg, RT; Sheridan, BC; Lund, JL; Serruys, PW
Published Date
- March 2011
Published In
Volume / Issue
- 6 / 8
Start / End Page
- 936 - 941
PubMed ID
- 21330240
Pubmed Central ID
- PMC3061312
Electronic International Standard Serial Number (EISSN)
- 1969-6213
Digital Object Identifier (DOI)
- 10.4244/EIJV6I8A163
Language
- eng
Conference Location
- France