Does previous percutaneous coronary stenting compromise the long-term efficacy of subsequent coronary artery bypass surgery? A microsimulation study
Φόρτωση...
Ημερομηνία
Συγγραφείς
Rao, C.
Stanbridge Rde, L.
Chikwe, J.
Pepper, J.
Skapinakis, P.
Aziz, O.
Darzi, A.
Athanasiou, T.
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
peer-reviewed
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Ann Thorac Surg
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
BACKGROUND: This study aims to compare long-term survival and health-related quality of life in patients undergoing coronary artery bypass surgery with and without previous coronary stenting. METHODS: Markov microsimulation was used to model long-term survival and quality of life after surgical revascularization using data from referenced sources. Probabilistic sensitivity analysis was used to investigate the effect of uncertainty associated with the model parameters on the microsimulation results. RESULTS: Percutaneous coronary stenting was found to significantly decrease the effectiveness of coronary surgery. The model suggests that after a single stenting procedure ten-year survival was reduced by 3.3% (SD 0.7%), from 79.9% (SD 1.3%) to 76.6% (SD 1.4%). Similarly, after multiple stenting procedures ten-year survival was reduced by 3.5% (SD 0.7%) to 76.4% (SD 1.4%). Over a ten-year period a single stenting procedure reduced the quality adjusted life year (QALY) payoff by 0.25 QALY (SD 0.11 QALY) and multiple stenting procedures reduced the QALY payoff by 0.27 QALY (SD 0.08 QALY). CONCLUSIONS: This study suggests that patients who undergo surgical bypass after stenting have worse long-term outcomes than patients who undergo surgical revascularization without previous percutaneous intervention. The pathophysiological mechanisms for this are not fully understood and must be further investigated. The findings of this study suggest that the timing of surgical bypass in relation to percutaneous intervention is important. This may have significant implications for clinical practice, suggesting that greater emphasis should be placed on selecting the optimum initial revascularization strategy.
Περιγραφή
Λέξεις-κλειδιά
Angioplasty, Balloon, Coronary/methods/mortality, Cause of Death, Coronary Artery Bypass/methods/*mortality, Coronary Stenosis/radiography/*therapy, Follow-Up Studies, Humans, *Markov Chains, *Models, Cardiovascular, Models, Statistical, Myocardial Revascularization/*methods, Quality of Life, *Quality-Adjusted Life Years, Reoperation, Risk Assessment, *Stents, Survival Analysis, Time Factors
Θεματική κατηγορία
Παραπομπή
Σύνδεσμος
http://www.ncbi.nlm.nih.gov/pubmed/18222252
http://ac.els-cdn.com/S0003497507019844/1-s2.0-S0003497507019844-main.pdf?_tid=a9f082321c1919cdc7e190bf5f98c9f0&acdnat=1333010389_6b1b8d7bc29666fc079352735f5e5470
http://ac.els-cdn.com/S0003497507019844/1-s2.0-S0003497507019844-main.pdf?_tid=a9f082321c1919cdc7e190bf5f98c9f0&acdnat=1333010389_6b1b8d7bc29666fc079352735f5e5470
Γλώσσα
en
Εκδίδον τμήμα/τομέας
Όνομα επιβλέποντος
Εξεταστική επιτροπή
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής