Clinical and economic impact of coronary artery bypass graft and percutaneous coronary intervention in young individuals with acute coronary syndromes and multivessel disease: A real-world comparison in a middle-income country

Abstract

BackgroundIn recent decades, the world watched a dramatic increase in the incidence of acute coronary syndromes (ACS) among young individuals (≤55 years-old) and a relative decrease in the elderly. The management of ACS in young patients with multivessel disease still needs to be elucidated, as these individuals maintain a long life expectancy.Research QuestionTo compare clinical outcomes and care costs in individuals with premature ACS and multivessel disease undergoing coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI).Methods and ResultsParticipants included all individuals ≤55 years-old admitted with ACS to public hospitals in Brasília (Brazil) between 2013 and 2015 and who underwent cardiac catheterization with SYNTAX score ≥23 or Duke category 6. Outcomes were adjudicated with death certificates and data from medical records. The primary outcome was the occurrence of major adverse cardiovascular events (MACE), defined as death due to cardiovascular causes, recurrent hospitalizations due to cardiovascular ischemic events, and incident heart failure New York Heart Association III-IV. As secondary outcome we assessed indirect and direct costs by evaluating the cost of lost productivity (in international dollars (Int$) per year) due to illness and death, outpatient costs and costs with new hospitalizations. Multivariate and principal components (PC) adjusted analyzes were performed.ResultsAmong 1,088 subjects (111 CABG and 977 PCI) followed for 6.2 years (IQR: 1.1), 304 primary events were observed. MACE was observed in 20.7% of the CABG group and 28.8% of the PCI group (p = 0.037). In multivariate analyses, PCI was associated with a hazard ratio (HR) = 1.227 (95% CI: 1.004–1.499; p = 0.0457) for MACE, and in PC-adjusted HR = 1.268 (95% CI: 1.048–1.548; p = 0.0271) compared with CABG. Despite direct costs were equivalent, the cost due to the loss of labor productivity was higher in the PCI group (Int$ 4,511 (IQR: 18,062)/year vs Int$ 3,578 (IQR: 13,198)/year; p = 0.049], compared with CABG.ConclusionsAmong young individuals with ACS and multivessel disease, surgical strategy was associated with a lower occurrence of MACE and lower indirect costs in the long-term.

Evaluate the Quality of Life in Patients With Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft

“…In participants of the current study, the average monthly expenditure for PCI and CABG were $318.23 and $334.96, respectively. A study conducted in Brazil, a middle-income country, found that direct costs were not different between CABG and PCI patients with a median of $630.72 and $672.29, respectively [ 33 ].…”

Estatística Cardiovascular – Brasil 2023

“…Os custos diretos para CRVM e ICP foram equivalentes (Int$ 3.141 [IIQ: 15.392]/ano e Int$ 3.348 [IIQ: 17.884]/ano), enquanto o custo por perda de produtividade laboral foi mais alto no grupo ICP (Int$ 4.511 [IIQ: 18.062]/ano e Int$ 3.578 [IIQ: 13.198]/ano, p = 0,049) em comparação ao grupo CRVM. 134 …”

The framing of time-dependent machine learning models improves risk estimation among young individuals with acute coronary syndromes

“…In addition to amplifying ACS-related reduction in quality of life and life expectancy, yACS also carries a heavy economic burden by reducing work capacity in early adulthood [3][4][5] .Young individuals with ACS are more likely to be men, smokers, obese, sedentary or to present familialcombined hyperlipidemia, and they more frequently consume cocaine or androgenic anabolic steroids than older ACS patients 6,7 . Furthermore, compared with older individuals, those with yACS have a higher proportion of traditional cardiovascular risk factors out of control 7,8 . This setting of frequent uncontrolled risk factor among yACS triggers a relevant economic impact 8 .…”