title: Risk-benefit trade-offs in revascularisation choices.
abstract: OBJECTIVE
  When patients choose percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG), they accept an increased long-term risk of repeat revascularisation in exchange for short-term morbidity benefits. This paper quantifies the risk-benefit trade-off faced by patients with multiple vessel coronary artery disease.
  
  
  RESULTS
  Data from the Arterial Revascularisation Therapies Study are used to generate risk-benefit acceptability curves for PCI versus CABG. Risks are measured by the long-term likelihood of repeat revascularisation while benefits are measured by short-term reductions in pain or improvements in health-related quality of life (HRQL). PCI patients faced a risk of 0.81 additional revascularisation events over three years in exchange for being pain-free at one month. A patient would need to be willing to tolerate a risk of 1.06 additional revascularisation events at three years, in exchange for being pain free at one month to be 95% confident that choosing PCI over CABG is risk-effective for him/her.
  
  
  CONCLUSIONS
  The risk-benefit framework outlined in this study provides information to enable physicians to help their patients weigh directly each procedure's risks and benefits. While trade-offs are typically measured in quality-adjusted life years, using pain reduction to reflect benefits may provide a more tangible framework for patients.
authors.affiliation: School of Medicine, Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA.
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Federspiel
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheridan
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lund
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000706:statistics & numerical data; D002637:Chest Pain / Q000401:mortality / Q000601:surgery / Q000628:therapy; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy; D003661:Decision Support Techniques; D006801:Humans; D015233:Models, Statistical; D009017:Morbidity; D009204:Myocardial Revascularization / Q000401:mortality* / Q000706:statistics & numerical data; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D019233:Retreatment / Q000401:mortality / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors