Abstract 18074: Patient Perception of Risk for Multi-Vessel Coronary Artery Disease Revascularization
Physicians alter clinical practice based on interventional trial results using major adverse cardiovascular events (MACE) as a grouped endpoint. Recently, the SYNTAX Trial studied revascularization of multi-vessel coronary artery disease (MV-CAD) using a MACE endpoint of death, stroke, myocardial infarction and repeat procedure. When designing trials and drawing conclusions, investigators imply that each part of a MACE endpoint is valued equally. However, patients may draw different conclusions. We hypothesize that patients and physicians given hypothetical revascularization scenarios do not value the endpoints of death, stroke and repeat procedure equally.
Methods: Twenty six cardiac care physicians and 315 patients with known or suspected CAD were given hypothetical scenarios detailing revascularization of MV-CAD. Based on the SYNTAX Trial, subjects were given risks of death, stroke, and need for second revascularization procedure (3%, 2% and 5% respectively) within one year of surgical bypass. Subjects were then given varying levels of risk of death (2%, 4% or 6%), stroke (1% or 2%) and need for second revascularization procedure (7%, 11%, 15% or 17%) within one year of stent placement. They were instructed to choose stent or bypass based on the presented risks.
Results: See Figure 1 for interim results. Patients and physicians view MACE components differently across the presented risks, with the greatest difference being “stroke”. Doubling the stent death rate caused more patients to shift their choice toward bypass than did doubling stent stroke or repeat revascularization rate. Patients generally preferred stents across all scenarios, even when stent death risk is 6%.
Conclusion: When deciding on stents versus surgical bypass for MV-CAD, significant disparities exist in risk perception between physicians and patients. This has important implications in counseling patients on revascularization method, and future use of MACE endpoints.
- © 2010 by American Heart Association, Inc.