Source: DGNews  |  Posted 2 years ago

By Em Brown

ORLANDO, Fla -- March 29, 2009 -- The clinical benefits of coronary artery bypass graft (CABG) surgery do not justify its higher cost at 1 year, researchers announced here at the American College of Cardiology (ACC) 58th Annual Scientific Session.

Principal investigator David J. Cohen, MD, MSc, Saint Luke’s Mid America Heart Institute and University of Missouri, Kansas City, Missouri, discussed the findings from the Synergy Between PCI With Taxus(R) and Cardiac Surgery (SYNTAX) trial here on March 28 at a late-breaking clinical trials session.

Quality of life was evaluated in 1,800 patients with 3-vessel disease or left main coronary artery disease who were randomised to revascularisation with either CABG (n = 897) or percutaneous coronary intervention (PCI) plus paclitaxel-eluting stent placement (n = 903).

The preliminary findings from SYNTAX, presented in September 2008, showed that 1-year clinical outcomes, including death, myocardial infarction, and stroke were similar for PCI and CABG at 7.6% and 7.7%, respectively. Repeat revascularisation was more frequent in the PCI group at 13.5%, compared with a revascularisation rate of 5.9% with CABG.

At the current ACC meeting, however, Dr. Cohen announced that, while both stenting and CABG improved the overall quality of life, quality of life was significantly better after PCI. Chest pain was alleviated to a greater extent by 12 months with CABG, although the difference was only marginally significant.

“Our primary finding was that the average patient much preferred PCI,” Dr. Cohen reported.

Initially, CABG cost approximately $6,000 more than PCI, primarily due to higher hospital costs and much higher physician fees. During the next 12 months, however, the costs of PCI were approximately $2,500 per patient greater than those with CABG, primarily due to additional cardiovascular procedures and the need for long-term antiplatelet medication. By 1 year, the total cost of CABG was about $3,500 greater than the total costs associated with PCI.

PCI was “clearly preferable” to patients, Dr. Cohen noted, although those with the most severe disease benefitted more from CABG than PCI.

“The complexity of coronary disease -- determined by such factors as where the plaque was located, the number of lesions to treat, the length of lesions and whether they were calcified or layered with fragile blood clots -- had a substantial influence on cost-effectiveness,” said Dr. Cohen.

PCI led to better quality-adjusted life expectancy than CABG, and lower healthcare costs in straightforward 3-vessel or left main coronary disease. Findings were similar for patients with disease of intermediate complexity. For patients with complex 3-vessel disease, however, quality-adjusted life expectancy was better with CABG, while overall costs at 1 year were nearly identical for the 2 procedures.

Funding for this study was provided by a grant from Boston Scientific Corp, makers of the TAXUS stent.

[Presentation title: Health Related Quality of Life and US Based Economic Outcomes of PCI With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel and Left Main Coronary Artery Disease: 1-Year Results From the SYNTAX Trial. Abstract 2402]