title: Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary artery disease.
abstract: OBJECTIVE
  Determine if patients prefer multivessel percutaneous coronary intervention (mv-PCI) over coronary artery bypass graft surgery (CABG) for treatment of symptomatic multivessel coronary artery disease (mv-CAD) despite high 1-year risk.
  
  
  BACKGROUND
  Patient risk perception and preference for CABG or mv-PCI to treat medically refractory mv-CAD are poorly understood. We hypothesize that patients prefer mv-PCI instead of CABG even when quoted high mv-PCI risk.
  
  
  METHODS
  585 patients and 31 physicians were presented standardized questionnaires with a hypothetical scenario describing chest pain and medically refractory mv-CAD. CABG or mv-PCI was presented as treatment options. Risk scenarios included variable 1-year risks of death, stroke, and repeat procedures for mv-PCI and fixed risks for CABG. Participants indicated their preference of revascularization method based on the presented risks. We calculated the odds that patients or physicians would favor mv-PCI over CABG across a range of quoted risks of death, stroke, and repeat procedures.
  
  
  RESULTS
  For nearly all quoted risks, patients preferred mv-PCI over CABG, even when the risk of death was double the risk with CABG or the risk of repeat procedures was more than three times that for CABG (P < 0.0001). Compared to patients, physicians chose mv-PCI less often than CABG as the risk of death and repeat procedures increased (P < 0.001 and P = 0.004, respectively).
  
  
  CONCLUSIONS
  Patients favor mv-PCI over CABG to treat mv-CAD, even if 1-year risks of death and repeat procedures far exceed risk with CABG. Physicians are more influenced by actual risk and prefer mv-PCI less than patients despite similarly quoted 1-year risks.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kipp
authors.forename: James
authors.initials: J
authors.lastname: Lehman
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Israel
authors.forename: Niloo
authors.initials: N
authors.lastname: Edwards
authors.forename: Tara
authors.initials: T
authors.lastname: Becker
authors.forename: Amish N
authors.initials: AN
authors.lastname: Raval
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057240:Patient Preference; D010465:Perception; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome