Resource Use Following Revascularization for Multivessel Coronary Artery Disease

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the 2 revascularization modalities for patients with severe coronary artery disease. While CABG has often demonstrated benefits over PCI in multivessel coronary artery disease, analyses of cost effectiveness have previously shown conflicting results and are limited by sample size, follow-up time, and lack of contemporary data.

We performed an analysis of resource use following elective, urgent, or emergent PCI or CABG from January 1, 2009, to December 31, 2018, with up to 14 years of follow-up. A provincial database was used to collect the associated data. The average cost for each event was calculated from Canadian Institute of Health Information data and was adjusted for inflation on the basis of the Bank of Canada consumer price index. Cost for each group was calculated for readmission to the hospital and repeat revascularization. Secondary outcomes included rates of death, myocardial infarction, rehospitalization, and repeat revascularization.

Of 23 243 patients who underwent angiography, 7359 were included in this study. Overall costs and costs per patient were significantly higher following PCI compared with CABG. Patients who underwent PCI required $19 165 per person in inflation-adjusted health care resource costs compared with $12 612 for CABG. Furthermore, patients who underwent PCI had higher rates of death, myocardial infarction, rehospitalization, and repeat revascularization (P<0.001).

Patients with multivessel coronary artery disease experience fewer adverse events and use fewer health care resources after discharge following CABG compared with PCI. Appropriate selection of CABG versus PCI may help reduce readmissions and health care costs following revascularization.