Document Detail

Triple vessel revascularization: coronary angioplasty versus coronary artery bypass surgery: initial results and five-year follow-up. Comparative costs and loss of working days and wages.
MedLine Citation:
PMID:  10147165     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to compare early and late outcomes in patients undergoing PTCA or CABG for triple vessel disease. BACKGROUND: Although early results of PTCA/CABG randomized trials have recently become available, at present little data exists on long-term medical and socioeconomic effects of these treatment modalities in patients with triple vessel revascularization. METHODS: During 1986-87, 76 patients undergoing triple vessel PTCA and 85 patients having triple vessel CABG were selected from a consecutive series of patients having multivessel revascularization. Initial results and 5 year outcome, hospital stay and charges and out-of-work time were assessed from prospectively collected data. RESULTS: Clinical and morphological factors were similar in the PTCA and CABG groups. Hospital success and complications were also similar, except for higher mortality in the CABG cohort (0 vs. 3.5%). Five year follow-up showed no differences in survival, nonfatal infarction and angina-free status; however, there was a difference in need for repeat revascularization (PTCA 55.4% vs. CABG 6.3%, p less than 0.001). Repeat PTCA accounted for 49% of the revascularization in the PTCA cohort. Crossovers were similar (PTCA[CABG 6.8%; CABG[PTCA 6.3%, pNS). Predictors of late death in the entire population were female gender (p less than 0.0001), diabetes (p<0.05) and depressed LVEF (p less than 0.05). The choice of revascularization procedure (PTCA vs. CABG) was not an independent predictor of late death or MI. Analysis of initial hospital charges showed a 2:1 advantage in favor of PTCA but this advantage was lost in late followup due to the need for repeat revascularization in the PTCA group. However, the PTCA cohort lost fewer working days than CABG patients (3017 vs 5874 days) and therefore, lost less wages ($7,022 vs. $14,685). CONCLUSIONS: The study shows that for selected triple vessel disease patients, PTCA and CABG results are comparable after 5 years, though repeat revascularization (mainly due to restenosis) was necessary in the PTCA group to maintain these favorable results. After 5 years, hospital charges are similar in the 2 groups, though out-of-work time and lost wages were 2:1 in favor of PTCA.
R K Myler; R E Shaw; S H Stertzer; A Zapolanski; R Zipkin; M C Murphy; H Hecht; J Chan; L Mengarelli; D C Cumberland
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  6     ISSN:  1042-3931     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-08-25     Completed Date:  1994-08-25     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  125-35     Citation Subset:  T    
San Francisco Heart Institute, Seton Medical Center, Daly City, California 94015.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary* / economics,  methods
Coronary Artery Bypass* / economics,  methods
Coronary Disease / mortality,  surgery,  therapy*
Evaluation Studies as Topic
Follow-Up Studies
Health Care Costs
Length of Stay
Retrospective Studies
Socioeconomic Factors
Survival Analysis
Treatment Outcome*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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