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

International Standard Serial Number (ISSN)

  • 1774-024X

Digital Object Identifier (DOI)

  • 10.4244/eijv6i8a163

Language

  • eng