Comparison of multiple drug-eluting stent percutaneous coronary intervention and surgical revascularization in patients with multivessel coronary artery disease: one-year clinical results and total treatment costs.
OBJECTIVE
Consecutive patients with multivessel coronary artery disease treated with multiple drug-eluting-stent (DES) percutaneous coronary intervention (PCI) (111 patients) or coronary artery bypass graft (CABG) (95 patients) on the basis of clinico-anatomical judgment were examined to investigate mediumterm clinical results and initial and total costs.


METHODS
Clinical and procedural characteristics, duration of hospital stay, initial and total costs and 12-month follow-up events were considered in both groups.


RESULTS
Previous revascularization procedures and acute coronary syndromes were more frequent in the PCI group, while triple-vessel and left main disease occurred more often in the CABG group. The mean number of treated vessels in multiple DES PCI was 2.7/patient, with 2.8 DES/patient. Complete revascularization was achieved in 70% of cases. Inhospital events were postprocedural non-Q-wave acute myocardial infarction in 5.4%, and 2 retroperitoneal hemorrhages. CABG was performed with a mean of 3.9 grafts/patient; 16 patients (17%) had early complications; mean hospital stay was significantly longer than for the PCI patients (23.5 +/- 10 vs. 5.3 +/- 3 days; p < 0.001). Twelve-month total mortality and acute myocardial infarction incidents were similar, while target vessel revascularization was significantly more frequent in the PCI group (12.6% PCI vs. 2.1% CABG; p < 0.001); cumulative major adverse cardiac events were not significantly different (15.3% PCI vs. 9.5% CABG; p = 0.271). Initial and final costs were lower for multivessel PCI with DES (20,050 +/- 2,702 for CABG vs. 10,214 +/- 4,184 for PCI; p < 0.001), but not completely covered by current DRG reimbursement.


CONCLUSIONS
Multiple DES PCI showed good earlyand medium-term results with substantially lower costs than CABG.
Varani
Elisabetta
E
Department of Cardiologo, Ospedale S. Maria delle Croci, Viale Randi, 5, 48100, Ravenna, Italy.
Balducelli
Marco
M
Vecchi
Giuseppe
G
Aquilina
Matteo
M
Maresta
Aleardo
A
D054058:Acute Coronary Syndrome / Q000191:economics / Q000601:surgery / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics*; D001026:Coronary Artery Bypass / Q000191:economics*; D003324:Coronary Artery Disease / Q000191:economics / Q000601:surgery* / Q000628:therapy*; D023903:Coronary Restenosis / Q000191:economics / Q000601:surgery / Q000628:therapy; D003331:Coronary Vessels / Q000601:surgery; D003365:Costs and Cost Analysis; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000601:surgery / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome