Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiovascular Surgery

Background:

• Patient risk perception and treatment preferences for multivessel coronary artery disease (mv-CAD) remain unclear.
• Understanding these preferences is crucial for shared decision-making in revascularization strategies.

Purpose of the Study:

• To determine patient preference between multivessel percutaneous coronary intervention (mv-PCI) and coronary artery bypass graft surgery (CABG) for symptomatic mv-CAD.
• To compare patient and physician preferences for these revascularization methods under varying risk scenarios.

Main Methods:

• A hypothetical scenario of medically refractory mv-CAD was presented to 585 patients and 31 physicians.
• Participants indicated their preferred treatment (mv-PCI or CABG) based on variable 1-year risks of death, stroke, and repeat procedures for mv-PCI versus fixed risks for CABG.
• Statistical analysis calculated the odds of favoring mv-PCI over CABG across different risk levels.

Main Results:

• Patients overwhelmingly preferred mv-PCI over CABG, even when mv-PCI carried double the risk of death or triple the risk of repeat procedures.
• Physicians were more risk-averse than patients, opting for CABG more frequently as the quoted risks for mv-PCI increased.
• Physician preference for mv-PCI decreased significantly with higher risks compared to patient preference.

Conclusions:

• Patients demonstrate a strong preference for mv-PCI over CABG for treating mv-CAD, irrespective of significantly higher associated risks.
• Physicians' treatment preferences are more closely aligned with objective risk assessment than patient preferences.
• This highlights a potential discordance between patient desires and physician-recommended strategies in mv-CAD management.