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Patients' preferences for coronary bypass grafting or staged percutaneous coronary intervention in multi-vessel
Marc-Alexander Ohlow1, Ahmed Farah2, Thomas Kuntze3
1Department of Cardiology, Zentralklinik, Bad Berka, Germany.
Insights
Most patients with multi-vessel coronary artery disease (mCAD) prefer staged percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG). Patient preference for PCI increases with age and history of CABG complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The choice between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease (mCAD) typically involves a heart team.
- Patient preferences in these decisions are not extensively studied.
Purpose of the Study:
- To investigate patient preferences between CABG and PCI for mCAD in a hypothetical scenario.
- To identify factors influencing patient choice between these revascularization strategies.
Main Methods:
- A survey of 213 patients with prior CABG and at least two PCI procedures was conducted.
- Participants were asked to choose between CABG or staged PCI for a hypothetical mCAD scenario with equal expected outcomes.
Main Results:
- A majority (67%) preferred staged PCI, while 15% preferred CABG, and 18% were indifferent.
- Shorter recovery duration and longer symptom-free periods were reported for PCI compared to CABG.
- Preference for PCI was higher in patients aged 70 or older, those with prior CABG complications, and those who underwent CABG first.
Conclusions:
- Staged PCI is preferred over CABG by most patients in this hypothetical scenario.
- Patient age, prior CABG complications, and the sequence of procedures influence treatment preference.
Background:
The decision for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with multi-vessel coronary artery disease (mCAD) is currently made by a heart-team approach. Patients' preference is less well investigated.
Methods:
All consecutive patients with prior CABG and at least 2 PCI procedures were interviewed whether they would elect bypass surgery or staged PCI in case of a hypothetical scenario in which they had mCAD and CABG or PCI will equally improve symptoms and survival.
Results:
A total 213 patients were surveyed. About 21 (10%) patients had multiple CABG, and mean number of PCI per patient was 4.0 ± 2.7. Complications during CABG were reported in 19.7% and in 14% after PCI, respectively. About 15% experienced complications after both CABG and PCI, and 51% had no complications at all. Mean symptom-free period was 5.2 (following CABG) vs 1.8 years (following PCI); P<.001. Duration of recovery was significant shorter after PCI (mean 9.2 ± 1.2 vs 136.4 ± 57.9 days; P<.01). Based on their personal experience with both procedures, 15% of the participants elected CABG in the hypothetical scenario and 67% choose staged PCI, 18% were equally happy with either. More participants preferred PCI when age was ≥70, complications following CABG occurred, and when undergoing CABG first. Gender, number of CABG or PCI procedures per patient, and complications following PCI did not affect participants' preference.
Conclusions:
In our hypothetical scenario, the majority of participants preferred staged PCI over CABG. Preferences were related to age, complications following CABG, and whether CABG was performed first.