Risk-benefit trade-offs in revascularisation choices.
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.
Duke Scholars
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Related Subject Headings
- Risk Factors
- Risk Assessment
- Retreatment
- Randomized Controlled Trials as Topic
- Quality of Life
- Myocardial Revascularization
- Morbidity
- Models, Statistical
- Humans
- Decision Support Techniques
Citation
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Risk Factors
- Risk Assessment
- Retreatment
- Randomized Controlled Trials as Topic
- Quality of Life
- Myocardial Revascularization
- Morbidity
- Models, Statistical
- Humans
- Decision Support Techniques