Three-year follow-up of the argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI)

Rodríguez, Alfredo E.; Mele, Eduardo; Peyregne, Ernesto; Bullon, Fernando; Perez-Baliño, Nestor; Liprandi, María Inés Sosa; Palacios, Igor F.

doi:10.1016/0735-1097(95)00592-7

Cited by 96 publications

(50 citation statements)

References 31 publications

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“…30 The difference in costs between the PCI and CABG strategies has varied somewhat among studies, ranging from a 5% gap at 5 years 31 to a 45% gap at 3 years. 32 The 19% gap in average total costs favoring PCI at 5 years found in AWESOME was somewhat greater than in prior trials.…”

Section: Discussionmentioning

confidence: 78%

Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Stroupe¹,

Morrison

Hlatky

et al. 2006

Circulation

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Background-A Department of Veterans Affairs Cooperative Study randomized high-risk patients with medically refractory myocardial ischemia, a group largely excluded from previous trials, to urgent revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients. Methods and Results-Of 454 patients at 16 Department of Veterans Affairs medical centers, 445 were available for the economic analysis (218 PCI and 227 CABG patients). Total costs were assessed at 3 and 5 years from the third-party payer's perspective, and effectiveness was measured by survival. After 3 years, average total costs were $63 896 for PCI versus $84 364 for CABG patients, a difference of $20 468 (95% confidence interval [CI] $13 918 to $27 569). CIs were estimated by bootstrapping. Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients (Pϭ0.34). Precision of the cost-effectiveness estimates were assessed by bootstrapping. PCI was less costly and more effective at 3 years in 92.6% of the bootstrap replications. After 5 years, average total costs were $81 790 for PCI versus $100 522 for CABG patients, a difference of $18 732 (95% CI $9873 to $27 831), whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients (Pϭ0.21). At 5 years, PCI remained less costly and more effective in 89.4% of the bootstrap replications. Conclusions-PCI was less costly and at least as effective for the urgent revascularization of medically refractory, high-risk patients over 5 years.

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Section: Discussionmentioning

confidence: 78%

Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Stroupe¹,

Morrison

Hlatky

et al. 2006

Circulation

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“…7,9,15,28,[35][36][37][38][39] However, most of these studies are limited by relatively short follow-up durations 7,34,36,39 or Costs and QALYs are discounted at 3% per year. Δ indicates difference between CABG and PCI groups; CABG, coronary artery bypass grafting; CI, confidence interval; ICER, incremental cost-effectiveness ratio for coronary artery bypass grafting versus percutaneous coronary intervention; LM, left main; PCI, percutaneous coronary intervention; QALY, quality-adjusted life-year gained; and SYNTAX, Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel or Left Main Coronary Artery Disease

et al. 2014

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A pproximately 6% of all American adults suffer from coronary artery disease (CAD), with estimated total annual costs in excess of $200 billion.1 Coronary revascularization procedures, including percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), account for nearly $12 billion per year in direct costs alone.Background-The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial demonstrated that in patients with 3-vessel or left main coronary artery disease, coronary artery bypass graft surgery (CABG) was associated with a lower rate of cardiovascular death, myocardial infarction, stroke, or repeat revascularization compared with percutaneous coronary revascularization with drug-eluting stents (DES-PCI)). The longterm cost-effectiveness of these strategies is unknown. Methods and Results-Between 2005 and 2007, 1800 patients with left main or 3-vessel coronary artery disease were randomized to CABG (n=897) or DES-PCI (n=903). Costs were assessed from a US perspective, and health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on the 5-year in-trial data was used to extrapolate costs, life expectancy, and quality-adjusted life expectancy over a lifetime horizon. Although initial procedural costs were $3415 per patient lower with CABG, total hospitalization costs were $10 036 per patient higher. Over the next 5 years, follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations, revascularization procedures, and higher medication costs. Over a lifetime horizon, CABG remained more costly than DES-PCI, but the incremental cost-effectiveness ratio was favorable ($16 537 per quality-adjusted life-year gained) and remained <$20 000 per quality-adjusted life-year in most bootstrap replicates. Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs. In patients with left main disease or a SYNTAX score ≤22, however, DES-PCI was economically dominant compared with CABG, although these findings were less certain. Conclusions-For most patients with 3-vessel or left main coronary artery disease, CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI. However, among patients with less complex disease, DES-PCI may be preferred on both clinical and economic grounds.

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“…If an incomplete PCI revascularization strategy is used, stress testing may identify a high-risk subset of patients for whom additional revascularization procedures reduce subsequent ischemic events [86,87]. King 1994 50% CABRI [28] CABRI investigators 1995 50% ERACI [29] Rodriguez 1996 70% French monocentric study [30] Carrie 1997 70% BARI [31] BARI One-stage multivessel PCI is reasonable when the following conditions have been met: (a) multiple vessels have hemodynamically significant lesions (either angiographically severe or, if intermediate, proven by stress testing or invasive testing to be significant), (b) indications for PCI are present (e.g., to relieve symptoms in stable angina or to prevent death or recurrent ischemic events for acute coronary syndrome patients), (c) adequate informed consent was obtained and consideration of alternatives has occurred, (d) the first stage of PCI is uncomplicated and without excessive radiation or contrast doses, (e) the patient and the operator are willing to proceed with multivessel PCI, and (f) the impact of resulting delays for other patients and operators has been considered.…”

Section: Strategies For Multivessel Pci Complete Versus Incomplete Rementioning

confidence: 99%

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

Blankenship

Moussa

Chambers

et al. 2011

Cathet Cardio Intervent

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Percutaneous coronary interventions (PCIs) to treat multivessel coronary artery disease (MVCAD) may involve single-vessel or multivessel interventions, performed in one or more stages. This consensus statement reviews factors that may influence choice of strategy and includes six recommendations to guide decisions regarding staging of PCI [1]. Every patient who undergoes PCI should receive optimal therapy for coronary disease, ideally before starting the procedure [2]. Multivessel PCI at the time of diagnostic catheterization should be considered only if informed consent included the risks and benefits of multivessel PCI and the risks and benefits of alternative treatments [3]. When considering multivessel PCI, the interventionist should develop a strategy regarding which stenoses to treat or evaluate, and their order, method, and timing. This strategy should maximize patient benefits, minimize patient risk, and consider the factors described in this article [4]. For planned multivessel PCI, additional vessel(s) should be treated only if the first vessel is treated successfully and if anticipated contrast and radiation doses and patient and operator conditions are favorable [5]. After the first stage of the planned multistage PCI, the need for subsequent PCI should be reviewed before it is performed [6]. Third party payers and quality auditors should recognize that multistage PCI for MVCAD is neither an indication of poor quality nor an attempt to increase reimbursement when performed according to recommendations in this article.V C 2011 Wiley Periodicals, Inc.

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Three-year follow-up of the argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI)

Cited by 96 publications

References 31 publications

Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Cost-Effectiveness of Coronary Artery Bypass Grafts Versus Percutaneous Coronary Intervention for Revascularization of High-Risk Patients

Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel or Left Main Coronary Artery Disease

Staging of multivessel percutaneous coronary interventions: An expert consensus statement from the Society for Cardiovascular Angiography and Interventions

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