RESUMO
BackgroundOur aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and ResultsPatients (n51205) were randomly assigned to stent implantation (n5600; diabetic, 112) or CABG (n5605; diabetic, 96). Costs per patient were calculated as the product of each patients use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, P,0.001) and nondiabetic patients treated with stents (76.2%, P50.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were $12 855 and $16 585 (P,0.001) and in the nondiabetic groups, $10 164 for stenting and $13 082 for surgery. ConclusionsMultivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status.
Assuntos
Diabetes Mellitus , Doença das Coronárias , Revascularização MiocárdicaRESUMO
Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies.Patients (N= 1205) were randomly assigned to stent implantation (n= 600; diabetic, 112) or CABG (n=605; diabetic, 96). Costs per patient were calculated as the product of each patient's useof resources and the corresponding unit costs.Baseline charcteristics were similar between the groups. At 1 year , diabetic patient treated with stenting had the lowest event-free survival rate (63,4%) because of a higher incidence of repeat revascularization compared with both diabetics patients...
Assuntos
Diabetes Mellitus/cirurgia , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/prevenção & controle , Doença da Artéria Coronariana/terapia , Revascularização Miocárdica/economia , Revascularização Miocárdica/métodosRESUMO
BackgroundCoronary stenting improves outcomes compared with balloon angioplasty, but it is costly and may haveother disadvantages. Limiting stent use to patients with a suboptimal result after angioplasty (provisional angioplasty) may be as effective and less expensive.Methods and ResultsTo analyze the cost-effectiveness of provisional angioplasty, patients scheduled for single-vessel angioplasty were first randomized to receive primary stenting (97 patients) or balloon angioplasty guided by Doppler flow velocity and angiography (523 patients). Patients in the latter group were further randomized after optimization to either additional stenting or termination of the procedure to further investigate what is optimal. An optimal result wasdefined as a flow reserve 2.5 and a diameter tenosis 36%. Bailout stenting was needed in 129 patients (25%) who were randomized to balloon angioplasty, and an optimal result was obtained in 184 of the 523 patients (35%). There was no significant difference in event-free survival at 1 year between primary stenting (86.6%) and provisional angioplasty (85.6%). Costs after 1 year were significantly higher for provisional angioplasty (EUR 6573 versus EUR 5885; (P50.014). Results after the second randomization showed that stenting was also more effective after optimal balloon angioplasty (1-year event free survival, 93.5% versus 84.1%; P50.066). ConclusionsAfter 1 year of follow-up, provisional angioplasty was more expensive and without clinical benefit. The beneficial value of stenting is not limited to patients with a suboptimal result after balloon angioplasty.