Abstract
BackgroundRates of recommending percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) vary across clinicians. Whether clinicians agree on preferred treatment options for multivessel coronary artery disease patients has not been well studied.Methods and resultsWe distributed a survey to 104 clinicians from the Northern New England Cardiovascular Study Group through email and at a regional meeting with 88 (84.6%) responses. The survey described three clinical vignettes of multivessel coronary artery disease patients. For each patient vignette participants selected appropriate treatment options and whether they would use a patient decision aid. The likelihood of choosing PCI only or PCI/CABG over CABG only was modeled using a multinomial regression. Across all vignettes, participants selected CABG only as an appropriate treatment option 24.2% of the time, PCI only 25.4% of the time, and both CABG or PCI as appropriate treatment options 50.4% of the time. Surgeons were less likely to choose PCI over CABG (RR 0.14, 95% CI 0.03, 0.59) or both treatments over CABG only (RR 0.10, 95% CI 0.03, 0.34) relative to cardiologists. Overall, 65% of participants responded they would use a patient decision aid with each vignette.ConclusionsThere is a lack of consensus on the appropriate treatment options across cardiologists and surgeons for patients with multivessel coronary artery disease. Treatment choice is influenced by both patient characteristics and clinician specialty.
Highlights
The ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) varies between hospitals across the United States and Canada [1, 2]
There is a lack of consensus on the appropriate treatment options across cardiologists and surgeons for patients with multivessel coronary artery disease
Survey development The survey, available in the Data Supplement was developed by health services researchers at The Dartmouth Institute and Northern New England Cardiovascular Study Group (NNECDSG) and informed by a literature review of factors that influence the choice between CABG and PCI
Summary
The ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) varies between hospitals across the United States and Canada [1, 2]. Nichols et al BMC Cardiovasc Disord (2021) 21:410 to determine the practice patterns for stable coronary artery disease management [8]. Clinicians varied in their diagnostic test strategies, with 24% immediately requesting coronary angiography, 49% requesting stress testing, and 27% using medial therapy without further diagnostic testing for recurrent stable angina patients [8]. Rates of recommending percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) vary across clinicians. Whether clinicians agree on preferred treatment options for multivessel coronary artery disease patients has not been well studied
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