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Zhao Y, Meng S, Liu T, Dong R. Economic Analysis of Surgical and Interventional Treatments for Patients with Complex Coronary Artery Disease: Insights from a One-Year Single-Center Study. Med Sci Monit 2020; 26:e919374. [PMID: 32097388 PMCID: PMC7059453 DOI: 10.12659/msm.919374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Surgical treatment methods for patients with complex coronary artery disease (CAD) who have undergone vascular reconstruction mainly include coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). The purpose of the study aimed to compare a 1-year follow-up for the patient clinical outcomes and costs between PCI and CABG treatment. MATERIAL AND METHODS There were 840 patients enrolled in this study from July 2015 to September 2016. Among the study participants, 420 patients underwent PCI treatment and 420 patients underwent off-pump CABG. Patients costs were assessed from the perspective of the China healthcare and medical insurance system. EuroQOL 5-dimension 3 levels (EQ-5D-3L) questionnaire was used to evaluate the general health status, and the Seattle Angina Questionnaire (SAQ) was used to assess the disease-specific health status. RESULTS After a 1-year follow-up, the all-cause mortality (P=0.0337), the incidence of major adverse cardiac and cerebrovascular events (P<0.001), and additional revascularization (P<0.001) in PCI group were significantly higher than those in CABG group. Both groups have significant sustained benefits in the SAQ subscale. The CABG group had a higher score on the frequency of angina than the PCI group. In addition, the quality-adjusted life year value of PCI and CABG resulted was 0.8. The average total cost for PCI was $14 643 versus CABG cost of $13 842 (P=0.0492). CONCLUSIONS In the short-term, among the CAD patients with stable triple-vessel or left-main, costs and clinical outcomes are substantially higher for CABG than PCI. Long-term, economic, and health benefits analysis, is warranted.
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Affiliation(s)
- Yang Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Shuai Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Taoshuai Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (mainland)
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Völz S, Angerås O, Koul S, Haraldsson I, Sarno G, Venetsanos D, Grimfärd P, Ulvenstam A, Hofmann R, Hamid M, Henareh L, Wagner H, Jensen J, Danielewicz M, Östlund O, Eriksson P, Scherstén F, Linder R, Råmunddal T, Pétursson P, Fröbert O, James S, Erlinge D, Omerovic E. Radial versus femoral access in patients with acute coronary syndrome undergoing invasive management: A prespecified subgroup analysis from VALIDATE-SWEDEHEART. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 8:510-519. [PMID: 31237158 DOI: 10.1177/2048872618817217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS In the Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated according to Recommended Therapies Registry Trial (VALIDATE-SWEDEHEART), bivalirudin was not superior to unfractionated heparin in patients with acute coronary syndrome undergoing invasive management. We assessed whether the access site had an impact on the primary endpoint of death, myocardial infarction or major bleeding at 180 days and whether it interacted with bivalirudin/unfractionated heparin. METHODS AND RESULTS A total of 6006 patients with acute coronary syndrome planned for percutaneous coronary intervention were randomised to either bivalirudin or unfractionated heparin. Arterial access was left to the operator discretion. Overall, 90.5% of patients underwent transradial access and 9.5% transfemoral access. Baseline risk was higher in transfemoral access. The unadjusted hazard ratio for the primary outcome was lower with transradial access (hazard ratio 0.53, 95% confidence interval 0.43-0.67, p<0.001) and remained lower after multivariable adjustment (hazard ratio 0.56, 95% confidence interval 0.52-0.84, p<0.001). Transradial access was associated with lower risk of death (hazard ratio 0.41, 95% confidence interval 0.28-0.60, p<0.001) and major bleeding (hazard ratio 0.57, 95% confidence interval 0.44-0.75, p<0.001). There was no interaction between treatment with bivalirudin and access site for the primary endpoint (p=0.976) or major bleeding (p=0.801). CONCLUSIONS Transradial access was associated with lower risk of death, myocardial infarction or major bleeding at 180 days. Bivalirudin was not associated with less bleeding, irrespective of access site.
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Affiliation(s)
- Sebastian Völz
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Sweden
| | - Inger Haraldsson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Giovanna Sarno
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Per Grimfärd
- Department of Internal Medicine, Västmanlands Sjukhus, Sweden
| | | | - Robin Hofmann
- Department of Clinical Science and Education, Karolinska Institutet, Sweden
| | - Mehmet Hamid
- Department of Cardiology, Mälarsjukhuset, Sweden
| | - Loghman Henareh
- Department of Cardiology, Karolinska University Hospital, Sweden
| | - Henrik Wagner
- Department of Cardiology, Helsingborg Lasarett, Sweden
| | - Jens Jensen
- Department of Clinical Science and Education, Karolinska Institutet, Sweden.,Unit of Cardiology, Capio S:t Görans Sjukhus, Sweden
| | | | - Ollie Östlund
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | | | | | | | - Pétur Pétursson
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden
| | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Sweden
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