Birim Ö, Bogers A J J C, Kappetein A P
Department of Cardio-Thoracic Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
J Cardiovasc Surg (Torino). 2012 Oct;53(5):641-50. Epub 2012 Jan 17.
Randomized trials have compared revascularization of coronary artery disease by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). CABG is an expensive treatment. However, it manages to improve quality of life, restore general well being, and alleviate symptoms of patients. Coronary stents have improved the safety and durability of PCI. Nonetheless, stenting remains limited by a relatively high in-stent restenosis and thrombosis rate. The costs and cost-effectiveness for these different treatment modalities are relevant issues because cardiovascular disease and its management are prime targets for cost reduction initiatives. There is a debate as to which is the optimal treatment strategy as well as to the cost-effectiveness comparing CABG and PCI. This review provides an overview of cost-effectiveness of CABG compared with PCI. PCI has high costs due to the need for subsequent revascularization procedures, with absence of mortality and survival benefit compared with CABG. Despite the relative lower initial costs of PCI in the first year, PCI is not a cost-effective intervention in comparison with CABG. However, the studies undertaken to date have predominantly been short term and provide a very limited evidence base by which to assess the cost-effectiveness of modern clinical practice. It seems that in longer term, the benefits of CABG may exceed those of stenting and the difference in net cost may be in favour of CABG as the risk of repeat revascularization still increases with PCI regardless of the use of DES. However, to date no long-term data are available in cost-effectiveness between CABG and PCI. The 5-year outcome of the ongoing SYNTAX trial is essential and might therefore provide new insights into the comparison of cost-effectiveness between CABG and DES PCI.
随机试验比较了冠状动脉搭桥术（CABG）和经皮冠状动脉介入治疗（PCI）对冠心病的血运重建效果。CABG是一种昂贵的治疗方法。然而，它确实能改善生活质量，恢复总体健康状况，并缓解患者症状。冠状动脉支架提高了PCI的安全性和耐用性。尽管如此，支架置入术仍受到较高的支架内再狭窄和血栓形成率的限制。这些不同治疗方式的成本和成本效益是相关问题，因为心血管疾病及其管理是成本降低举措的主要目标。关于哪种是最佳治疗策略以及比较CABG和PCI的成本效益存在争议。本综述概述了CABG与PCI相比的成本效益。由于需要后续的血运重建程序，PCI成本高昂，与CABG相比，没有死亡率和生存获益。尽管PCI在第一年的初始成本相对较低，但与CABG相比，PCI不是一种具有成本效益的干预措施。然而，迄今为止进行的研究主要是短期的，提供了非常有限的证据基础来评估现代临床实践的成本效益。从长期来看，CABG的益处似乎可能超过支架置入术，净成本差异可能有利于CABG，因为无论是否使用药物洗脱支架（DES），PCI的重复血运重建风险仍然会增加。然而，迄今为止尚无CABG和PCI之间成本效益的长期数据。正在进行的SYNTAX试验的5年结果至关重要，可能会因此为比较CABG和DES PCI的成本效益提供新的见解。
