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

Gustavo de Almeida Alexim; Luiza Ferreira Rocha; Giovani Prediger Dobri; Adair da Silva Rosa Júnior; Ricardo Torres Bispo Reis; Ana Claudia Cavalcante Nogueira; Alexandre Anderson de Souza Munhoz Soares; Andrei Carvalho Sposito; Ana Patricia de Paula; Luiz Sérgio Fernandes de Carvalho

doi:10.3389/fcvm.2022.1000260

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

Front Cardiovasc Med. 2022 Nov 10:9:1000260. doi: 10.3389/fcvm.2022.1000260. eCollection 2022.

Authors

Gustavo de Almeida Alexim^{1

2

3}, Luiza Ferreira Rocha^{3

4}, Giovani Prediger Dobri^{3

4}, Adair da Silva Rosa Júnior³, Ricardo Torres Bispo Reis⁵, Ana Claudia Cavalcante Nogueira^{2

3

6}, Alexandre Anderson de Souza Munhoz Soares⁶, Andrei Carvalho Sposito^{6

7}, Ana Patricia de Paula¹, Luiz Sérgio Fernandes de Carvalho^{1

2

6

8

9}

Affiliations

¹ Medical Sciences Post-Graduation Program, Escola Superior de Ciências da Saúde, Brasília, DF, Brazil.
² Medical Sciences Post-Graduation Program, University of Brasília, Brasília, DF, Brazil.
³ Secretaria de Estado de Saúde do Distrito Federal (SES-DF), Brasília, DF, Brazil.
⁴ Instituto de Cardiologia e Transplantes do Distrito Federal, Brasília, DF, Brazil.
⁵ Department of Mathematics and Statistics, University of Brasília, Brasília, DF, Brazil.
⁶ Aramari Apo Institute, Brasília, DF, Brazil.
⁷ Department of Cardiology, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
⁸ Laboratory of Data for Quality of Care and Outcomes Research, Clarity Healthcare Intelligence, Jundiaí, SP, Brazil.
⁹ Gerontology Post-Graduation Program, Universidade Católica de Brasília, Brasília, DF, Brazil.

Abstract

Background: In 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 question: To 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 results: Participants 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.

Results: Among 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.

Conclusions: Among 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.

Keywords: acute coronary syndromes (ACS); coronary artery bypass graft (CABG); costs; indirect cost estimation; outcomes assessment; percutaneous coronary intervention (PCI).