Detection of Restenosis following Percutaneous Coronary Angioplasty in Single-Vessel Coronary Artery Disease: The Value of Clinical Assessment and Exercise Tolerance Testing

Cardiology ◽  
1994 ◽  
Vol 84 (2) ◽  
pp. 106-113 ◽  
Author(s):  
Arie Roth ◽  
Hylton I Miller ◽  
Gad Keren ◽  
Bella Soffer ◽  
Shimon Kerbel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Clinical Assessment ◽  
Exercise Tolerance ◽  
Percutaneous Coronary Angioplasty ◽  
Exercise Tolerance Testing ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Vessel Coronary Artery ◽  
Tolerance Testing

scholarly journals Cost-effectiveness analysis of percutaneous coronary intervention for single-vessel coronary artery disease: an economic evaluation of the ORBITA trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044054
Author(s):  
Victoria McCreanor ◽  
Alexandra Nowbar ◽  
Christopher Rajkumar ◽  
Adrian G Barnett ◽  
Darrel Francis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Single Vessel ◽  
Vessel Coronary Artery Disease ◽  
Effectiveness Analysis ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Vessel Coronary Artery

ObjectiveTo evaluate the cost-effectiveness of percutaneous coronary intervention (PCI) compared with placebo in patients with single-vessel coronary artery disease and angina despite anti-anginal therapy.DesignA cost-effectiveness analysis comparing PCI with placebo. A Markov model was used to measure incremental cost-effectiveness, in cost per quality-adjusted life-years (QALYs) gained, over 12 months. Health utility weights were estimated using responses to the EuroQol 5-level questionnaire, from the Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial and UK preference weights. Costs of procedures and follow-up consultations were derived from Healthcare Resource Group reference costs and drug costs from the National Health Service (NHS) drug tariff. Probabilistic sensitivity analysis was undertaken to test the robustness of results to parameter uncertainty. Scenario analyses were performed to test the effect on results of reduced pharmaceutical costs in patients undergoing PCI, and the effect of patients crossing over from placebo to PCI due to refractory angina within 12 months.SettingFive UK NHS hospitals.Participants200 adult patients with stable angina and angiographically severe single-vessel coronary artery disease on anti-anginal therapy.InterventionsAt recruitment, patients received 6 weeks of optimisation of medical therapy for angina after which they were randomised to PCI or a placebo procedure.Outcome measuresIncremental cost-effectiveness ratio (ICER) expressed as cost (in £) per QALY gained for PCI compared with placebo.ResultsThe estimated ICER is £90 218/QALY gained when using PCI compared with placebo in patients receiving medical treatment for angina due to single-vessel coronary artery disease. Results were robust under sensitivity analyses.ConclusionsThe ICER for PCI compared with placebo, in patients with single-vessel coronary artery disease and angina on anti-anginal medication, exceeds the threshold of £30 000 used by the National Institute of Health and Care Excellence when undertaking health technology assessment for the NHS context.Trial registration: The ORBITA study is registered with ClinicalTrials.gov, number NCT02062593.

scholarly journals Percutaneous Coronary Angioplasty Compared With Exercise Training in Patients With Stable Coronary Artery Disease

Circulation ◽  
2004 ◽  
Vol 109 (11) ◽  
pp. 1371-1378 ◽  
Author(s):  
Rainer Hambrecht ◽  
Claudia Walther ◽  
Sven Möbius-Winkler ◽  
Stephan Gielen ◽  
Axel Linke ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Exercise Training ◽  
Coronary Angioplasty ◽  
Stable Coronary Artery Disease ◽  
Percutaneous Coronary Angioplasty ◽  
Percutaneous Coronary ◽  
Artery Disease

Real-world referral pattern and outcomes of diabetic patients who undergo revascularization: data from the prospective Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry†

2019 ◽  
Vol 56 (2) ◽  
pp. 328-334 ◽  
Author(s):  
Eilon Ram ◽  
Ilan Goldenberg ◽  
Leonid Sternik ◽  
Yael Peled ◽  
Amit Segev ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Term Survival ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Percutaneous Revascularization ◽  
Vessel Coronary Artery

Abstract OBJECTIVES Diabetes mellitus patients with multivessel coronary artery disease present with a poor prognosis. We aimed to explore real-life clinical outcomes of diabetic patients who were referred for coronary revascularization. METHODS We used data from the Multi-vessel Coronary Artery Disease (MULTICAD) Israeli Registry. Using descriptive statistics, Kaplan–Meier, Cox and logistic regression, we described a revascularization referral pattern, short-term outcomes and long-term survival among 475 diabetic patients with multivessel and/or left main disease, 48% of whom underwent surgical and 52% percutaneous revascularization. RESULTS Factors independently associated with referral for surgery included the presence of left main stenosis [odds ratio (OR) 1.89; P = 0.030] and a higher Syntax score (OR 1.15 per point increment; P < 0.001), whereas an older age (OR 1.03 per 1-year increment in age; P = 0.019), prior percutaneous coronary intervention (OR 1.83; P = 0.009) and the presence of renal impairment (OR 2; P = 0.026) were associated with percutaneous coronary intervention referral. At 7 months of follow-up, multivariable analysis did not reveal any difference in mortality risk between the surgical and percutaneous revascularization groups [hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.5–3.04; P = 0.649], whereas after 7 months, surgical revascularization was associated with a significant survival benefit (HR 2.24, 95% CI 1.03–4.87; P = 0.042). CONCLUSIONS Our observation suggests that in a real-world setting, only approximately one-half of diabetic patients with multivessel disease are referred to surgical revascularization despite guideline indications. Surgical compared to percutaneous revascularization in this population was associated with improved long-term survival that became evident 7 months after the revascularization procedure.

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