Does Previous Percutaneous Coronary Stenting Compromise the Long-Term Efficacy of Subsequent Coronary Artery Bypass Surgery? A Microsimulation Study

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Presentation transcript:

Does Previous Percutaneous Coronary Stenting Compromise the Long-Term Efficacy of Subsequent Coronary Artery Bypass Surgery? A Microsimulation Study Christopher Rao, MBBS, BSc, Rex De Lisle Stanbridge, FRCS, Joanna Chikwe, MBBS, FRCS, John Pepper, MBBS, MD, Petros Skapinakis, MSc, PhD, Omer Aziz, MRCS, Ara Darzi, MD, FRCS, Thanos Athanasiou, PhD, FETCS The Annals of Thoracic Surgery Volume 85, Issue 2, Pages 501-507 (February 2008) DOI: 10.1016/j.athoracsur.2007.09.036 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Markov microsimulation comparing long-term survival and health-related quality of life (HRQoL) after coronary artery bypass grafting (CABG) and CABG after percutaneous coronary stenting (PCS). Each patient cohort starts the simulation in one of states indicated by the shaded boxes and may remain in the same state, or move between states as indicated by the solid arrows. The probability of transition between states each cycle as well as the HRQoL associated with each state depends on the most recent method of revascularization. If revascularization occurs using a different method, indicated by the dashed arrows, the transition probabilities, and HRQoL associated with each state change. (CVA = cardiovascular accident; MI = myocardial infarction.) The Annals of Thoracic Surgery 2008 85, 501-507DOI: (10.1016/j.athoracsur.2007.09.036) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Survival curves for coronary artery bypass grafting (CABG) and CABG after percutaneous coronary stenting (PCS). — = CABG; − − − = CABG after PCS; - - - = CABG after multiple PCS. The Annals of Thoracic Surgery 2008 85, 501-507DOI: (10.1016/j.athoracsur.2007.09.036) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Survival after coronary artery bypass grafting estimated using Markov microsimulation compared with empirical registry data [6]. — = model data; – – – = registry data. The Annals of Thoracic Surgery 2008 85, 501-507DOI: (10.1016/j.athoracsur.2007.09.036) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The effect of percutaneous coronary stenting (PCS) on quality adjusted life year (QALY) payoff after coronary artery bypass grafting (CABG). — = CABG after PCS; – – – = CABG after multiple PCS. The Annals of Thoracic Surgery 2008 85, 501-507DOI: (10.1016/j.athoracsur.2007.09.036) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions