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A case-vignette based assessment of patient's perspective on coronary revascularization strategies, the OPINION study
Kaneshka Masdjedi1, Joost Daemen1, Roberto Diletti1
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Insights
Patients with significant left main artery disease often prefer percutaneous coronary intervention (PCI) over coronary artery bypass grafting (CABG), prioritizing lower risks of stroke and bleeding. Personality traits like Type D, depression, and anxiety are linked to a preference for CABG.
Area of Science:
- Cardiology
- Interventional Cardiology
- Psychocardiology
Background:
- Significant left main (LM) stem disease is a critical condition requiring revascularization.
- Treatment options include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).
- Patient preferences and personality traits may influence treatment choice.
Purpose of the Study:
- To evaluate patient preferences for PCI versus CABG for significant LM disease.
- To determine the importance patients place on specific procedural features.
- To investigate the influence of personality characteristics on treatment preference.
Main Methods:
- A case vignette-questionnaire was administered to 1145 outpatients with stable coronary artery disease.
- Patients completed standardized questionnaires assessing personality disposition and distress levels.
- Treatment preferences for a hypothetical significant LM stenosis were recorded.
Main Results:
- 89% of patients preferred PCI over CABG, even with a higher risk of repeat revascularization.
- Lower risk of stroke and bleeding were the most significant factors favoring PCI.
- Type D personality, depression, and anxiety correlated with a preference for CABG.
Conclusions:
- Patients generally prefer PCI for significant LM disease, prioritizing procedural safety (stroke, bleeding risk).
- Psychological factors, including Type D personality, depression, and anxiety, are associated with a preference for CABG.
- Understanding patient preferences and psychological profiles is crucial for shared decision-making in LM disease management.
Background And Aims:
Significant left main (LM) stem disease is potentially life-threatening and mandates revascularization. This study aimed to assess how patients rate the importance of particular features of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), how this determines their preference for a particular treatment strategy, and whether particular personality characteristics influence this preference.
Methods And Results:
In total, 1145 patients who visited the outpatient clinic of the Erasmus Medical Center for stable coronary artery disease were asked to complete a case vignette-questionnaire on a hypothetical significant LM stenosis amenable to PCI or CABG. To assess the individual's personality disposition and general distress level, each patient had to complete a set of 3 standardized, validated questionnaires with satisfactory psychometric properties. Overall 89% of patients preferred PCI to CABG. PCI was the preferred strategy despite a higher risk for repeat revascularization and need for more medication. Remarkably, the fact that a risk for repeat revascularization is more common in the PCI group is less important for the patients who opt for PCI. Risk for stroke and bleeding were the most important arguments to opt for PCI over CABG. Type D personality, depression, and anxiety were all associated with a relatively higher preference for CABG as revascularization strategy.
Conclusion:
Overall, when given the choice patients seem to have a clear preference for PCI over CABG and consider stroke and bleeding important procedure-related complications. Patients with Type D personality, depression, or anxiety favor CABG.