Clinical and economic outcomes of multivessel coronary stenting compared with bypass surgery: a single-center US experience.
BACKGROUND
Randomized trials comparing multivessel stenting with coronary artery bypass surgery (CABG) have demonstrated similar rates of death and myocardial infarction but higher rates of repeat revascularization after stenting. The impact of these alternative strategies on overall medical care costs is uncertain, particularly within the US health care system.


METHODS
We performed a retrospective, matched cohort study to compare the clinical and economic outcomes of multivessel stenting and bypass surgery. The stent group consisted of 100 consecutive patients who underwent stenting of >or=2 major native coronary arteries at our institution. The CABG group consisted of 200 patients who underwent nonemergent isolated bypass surgery during the same time frame, matched (2:1) for age, sex, ejection fraction, diabetes mellitus, and extent of coronary disease. Detailed clinical follow-up and resource utilization data were collected for a minimum of 2 years. Total costs were calculated by use of year 2000 unit prices.


RESULTS
Over a median follow up period of 2.8 years, there were no significant differences in all-cause mortality rates (3.0% vs 3.0%), Q-wave myocardial infarction (5.1% vs 4.0%), or the composite of death or myocardial infarction (7.1% vs 7.0%) between the stent and CABG groups (P = not significant for all comparisons). However, at 2-year follow up, patients with stents were more likely to require >or=1 repeat revascularization procedure (32.0% vs 4.5%, P <.001). The initial cost of multivessel stenting was 43% less than the cost of CABG (11,810 dollars vs 20,574 dollars, P <.001) and remained 27% less (17,634 dollars vs 24,288 dollars, P =.005) at 2 years.


CONCLUSIONS
Multivessel stenting and CABG result in comparable risks of death and myocardial infarction. Despite a higher rate of repeat revascularization, multivessel stenting was significantly less costly than CABG through the first 2 years of follow-up.
Reynolds
Matthew R
MR
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Neil
Nancy
N
Ho
Kalon K L
KK
Berezin
Ronna
R
Cosgrove
Roberta S
RS
Lager
Robert A
RA
Sirois
Cheryl
C
Johnson
Robert G
RG
Cohen
David J
DJ
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D003327:Coronary Disease / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003925:Diabetic Angiopathies / Q000191:economics / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome; D014481:United States