Using the risk of restenosis as a guide to triaging patients between surgical and percutaneous coronary revascularization

Circulation
Richard KettelkampJohn A Spertus

Abstract

Coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI) are strategies for treating coronary disease. Because the principal limitation of PCI is restenosis, CABG might be favored for those at high risk for restenosis. Using a clinical risk score for predicting restenosis, we examined whether patients with higher risks for restenosis were preferentially referred for CABG. A procedural registry of 2320 revascularization patients from whom data on procedure type, demographics, comorbid conditions, health status, vessel anatomy, and outcomes were taken was analyzed. Patients were classified and scored into 3 categories of restenosis risk ranging from 11% to 44%, as defined by 8 preprocedural characteristics. The objective of this study was to describe referral patterns between PCI and CABG in each category of risk. 2060 patients underwent nonemergent revascularization. 1404 of the patients underwent PCI and 656 were treated with CABG. Among the patients at low and intermediate risk for restenosis, twice as many were referred to PCI. Among those at the highest risk, 3-times as many were referred to PCI, resulting in a significant trend for those with the higher risks of restenosis to be preferentially r...Continue Reading

Citations

Jan 2, 2009·Implementation Science : IS·Carole DeckerJohn A Spertus
Sep 1, 2008·Circulation. Cardiovascular Quality and Outcomes·Suzanne V ArnoldJohn A Spertus
Sep 1, 2008·Circulation. Cardiovascular Quality and Outcomes·Sunil V Rao, Scott Y H Kim
Sep 27, 2005·Expert Review of Cardiovascular Therapy·Nicholas N KipshidzeJeffrey W Moses

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