Comparative effectiveness of treatment strategies for women. Coronary artery disease cad is a major cause of morbidity and mortality worldwide. Treatment strategies for patients with peripheral artery disease. Longterm survival prediction for coronary artery bypass grafting. Background hybrid coronary revascularization hcr involves the. Angiographic validation of the american college of cardiology. Comparative effectiveness and the united states healthcare system. In this era of cost containment, we performed a comparative effectiveness analysis of clinical outcomes and cost of the major anticoagulant strategies across all types of pci procedures in a large observational database. Pdf comparative effectiveness of revascularization. Prepared by the brown evidencebased practice center under contract no. Jan 18, 2017 clinical events reported occurred after initial revascularization therapy. The primary outcome was a composite outcome of allcause mortality, myocardial infarction, or revascularization through latest followup. Questions persist concerning the comparative effectiveness of percutaneous coronary intervention pci and coronaryartery bypass grafting cabg. However, the optimal strategy in patients with multivessel disease andor unprotected lms disease has remained controversial and the subject of many clinical trials in recent years.
Comparative effectiveness analysis of anticoagulant. Original article from the new england journal of medicine comparative effectiveness of revascularization strategies. Final results from the accfsts database collaboration on the. Effectiveness of percutaneous coronary intervention pci and coronary artery bypass grafting cabg for the treatment of patients with stable multivessel coronary artery disease is. Final results from the accfsts database collaboration on. Cabg in 2 or 3 vessel diseasehuge retrospective study controlling for confounding at 1 yearno significant difference in acm rr 0. In this 2009 report, the institute of medicines committee on comparative effectiveness research prioritization establishes a. International study of comparative health effectiveness with. Ascert researchers compare survival rates of two revascularization strategies posted on march 27, 2012 november 10, 2016 by ronel march 27, 2012 sean obrien, phd, and other dcri researchers provided data analysis for this largescale comparative effectiveness study. Despite intensive appraisal, there remain questions regarding the comparative effectiveness of the 2 forms of coronary revascularization therapy. Ascert american college of cardiology foundation and the society of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies was a large observational study designed to compare the longterm effectiveness of coronary artery bypass graft cabg and percutaneous coronary intervention pci to treat coronary artery disease cad over 4 to. The ascert study the national heart, lung, and blood institute of the national institutes of health nih has awarded a grant to the american college of cardiology acc in partnership with the society of thoracic surgeons sts to study the comparative effectiveness of the two forms of coronary revascularization. Comparative effectiveness of revascularization strategies article pdf available in new england journal of medicine 36616.
Costeffectiveness of revascularization strategies the. Costeffectiveness of revascularizationstrategies jacc. Impact of gender on arterial revascularization strategies for. Comparative effectiveness of endovascular and surgical. Accfaha pocket guideline management of patients undergoing. Comparative effectiveness of revascularization strategies article pdf available in indian heart journal 644. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. Comparative effectiveness of revascularization strategies. Comparative effectiveness of diagnostic testing strategies. Ascert american college of cardiology foundation and the society of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies was a large observational study designed to compare the longterm effectiveness of coronary artery bypass graft cabg and percutaneous coronary intervention pci to treat coronary artery disease cad over 4 to 5 years. Comparative effectiveness study of drugeluting and baremetal peripheral artery stents in endovascular femoropopliteal artery revascularization. Request pdf comparative effectiveness of revascularization strategies in stable ischemic heart disease. Cost effectiveness of revascularization strategies. Established role for carotid revascularization nascet.
The american college of cardiology foundation accf, the society of thoracic surgeons sts, and the duke clinical research institute are collaborating on a comparative effectiveness study american college of cardiology foundationsociety of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies. Challenges and importance of finding hidden confounders. Scientific advancements has not only resulted in better revascularization strategies over the time but has also contributed significantly to the medical management of coronary artery disease. Revascularization strategies and outcomes in elderly patients. The outcomes were examined across initial revascularization strategies, including bms, des, and cabg. Comparative effectiveness of coronary artery bypass grafting. Comparative effectiveness trials of imagingguided strategies in stable ischemic heart disease leslee j. This study examined the costeffectiveness of cabg versus pci for stable ischemic heart disease. Mar 27, 2012 ascert researchers compare survival rates of two revascularization strategies posted on march 27, 2012 november 10, 2016 by ronel march 27, 2012 sean obrien, phd, and other dcri researchers provided data analysis for this largescale comparative effectiveness study. Comparative effectiveness of endovascular versus surgical revascularization for acute lower extremity ischemia. A metaanalysis, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Weiss comparative effectiveness of revascularization strategies n.
The american college of cardiology foundation accf and the society of thoracic surgeons sts developed a partnership, the accf and sts database collaboration on the comparative effectiveness of revascularization strategies ascert, to compare the outcomes of pci and cabg, using information from records in their respective databases, with. Composite outcomes in coronary bypass surgery versus. Boden, md, facc, faha professor of medicine, albany medical college chief of medicine, stratton va medical center vicechairman, department of. We verified the performance of the propensity model by comparing the distribution of covariates and propensity scores between treatment groups both before and after inverse probability weighting. The search included comparative and noncomparative prospective studies that enrolled patients. In various clinical trials comparing the two revascularization strategies, mortality advantage for cabg has been found in some studies for patients with diabetes and complex coronary artery disease. Direct versus indirect revascularization procedures for. Revascularization strategies for patients with stable. Presented at the twentyseventh annual meeting of the eastern vascular society, white sulpher springs, wva, september 1922, 20. Initial national priorities for comparative effectiveness researchcer is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. Furthermore, the significant increase in revascularization associated with mps, ccta, and ee without a concomitant reduction in mi suggests that overdiagnosis is a legitimate concern in this patient population.
Costeffectiveness of revascularization strategies the ascert. Comparative effectiveness of revascularization strategies nejm. Although the therapeutic strategies for patients with stable coronary artery disease and preserved ventricular function have achieved similar outcomes in short and longterm followup, clinical events attributed to these different therapeutic forms are not considered comparatively under the parameters of costs and effectiveness 1, 2. International study of comparative health effectiveness. Treatment strategies for patients with peripheral artery.
In this scenario, expectations for additional surgical. Comparative effectiveness of treatment strategies for. Impact of gender on arterial revascularization strategies. The strategies of percutaneous coronary intervention pci and coronaryartery bypass grafting cabg for revascularization have been compared in randomized clinical trials.
Read comparative effectiveness of endovascular or surgical revascularization in patients with critical limb ischemia. Pdf comparative effectiveness of revascularization strategies. The comparative effectiveness of hybrid revascularization. Background ascert american college of cardiology foundation and the society of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies was a large observational study designed to compare the longterm effectiveness of coronary artery bypass graft cabg and percutaneous coronary intervention pci to treat coronary artery disease cad over. Effectiveness of percutaneous coronary intervention pci and coronary artery bypass grafting cabg for the treatment of patients with.
Similarly, differences in gender revascularization strategies. Hybrid coronary revascularization hcr combines surgical bypass with percutaneous. The evaluation of patients with suspected stable ischemic heart disease is among the most common diagnostic evaluations with nearly 20 million imaging and exercise stress tests performed annually in the united states. Boden importance of comparative effectiveness strategy. Douglas, mdf abstract the evaluation of patients with suspected stable ischemic heart disease is among the most common diagnostic. As shown in the courage trial, optimal medical therapy is at least as good as pci in mortality reduction for patients with stable coronary artery disease. In this analysis, we describe the comparative effectiveness of coronary artery bypass grafting cabg versus percutaneous coronary intervention pci in this patient population. Comparative effectiveness of revascularization strategies 10. The american college of cardiology foundation accf and the society of thoracic surgeons sts developed a partnership, the accf and sts database collaboration on the comparative effectiveness of revascularization strategies ascert, to compare the outcomes of pci and cabg, using information from records in their respective databases, with followup data from claims records of the centers for medicare and medicaid services cms. Clinical events reported occurred after initial revascularization therapy. Sts collaboration on the comparative effectiveness of. The american college of cardiology foundation accf and the society of thoracic surgeons sts collaborated to compare the rates of longterm survival after pci and cabg. For comparative effectiveness recommendations class i and iia.
Costeffectiveness of revascularization strategies jacc. Most strategies were not different between men and women. Dec 20, 2016 comparative effectiveness of management strategies for renal artery stenosis. Over the past 20 years, there have been 12 randomized trials in which the revascularization strategies of coronaryartery bypass grafting cabg and percutaneous coronary intervention pci have been compared, against the back. Accfaha pocket guideline management of patients undergoing coronary artery revascularization. Comparative effectiveness of revascularization strategies ncbi. Comparative effectiveness study of drugeluting and bare. In this era of cost containment, we performed a comparative effectiveness analysis of clinical outcomes and cost of the major anticoagulant strategies across all types of pci procedures in a large. Effective, adaptive learning that helps you prepare for certification, maintain competency, and sharpen clinical decisionmaking while earning cme and moc. Background ascert american college of cardiology foundation and the society of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies was a large observational study designed to compare the longterm effectiveness of coronary artery bypass graft cabg and percutaneous coronary intervention pci to treat coronary artery disease cad over 4 to 5.
Download fulltext pdf comparative effectiveness of revascularization strategies article pdf available in new england journal of medicine 36616. Database collaboration on the comparative effectiveness of revascularization strategies ascert, to compare the outcomes of pci and cabg, using information from records in their respective databases, with followup data from claims records of the centers for medicare and medicaid services cms. In this decision analysis, the authors compared the effectiveness of revascularization procedures in both adult and pediatric patients with mmd. Target limb revascularization, target lesion revascularization, acute limb ischemia. Arterial revascularization strategies between the sexes in the pmcs are presented in table 2. Jun 01, 2012 read comparative effectiveness analysis of anticoagulant strategies in a large observational database of percutaneous coronary interventions, journal of interventional cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Percutaneous coronary intervention pci is the most commonly used procedure for coronary revascularization. There are multiple adjuvant anticoagulation strategies available. Importance of comparative effectiveness strategy trials in clinical decisionmaking the courage to aim high william e. Comparative effectiveness and the united states healthcare. Title presented as comparative effectiveness of treatments for women with coronary artery disease title revised to comparative effectiveness of treatment strategies for women with coronary artery disease the revised title clarifies the reports focus on comparison of treatment strategies for this population. The strategies of percutaneous coronary intervention pci and. There are no prospective randomized trial data to guide decisions on optimal revascularization strategies for patients with multivessel coronary artery.
Accfaha pocket guideline management of patients undergoing coronary artery revascularization november 2011 adapted from the 2011 accfahascai guideline for percutaneous coronary intervention and the 2011 accfaha guideline for coronary artery bypass graft surgery developed in collaboration with the american association for thoracic. Comparative effectiveness of endovascular versus surgical. Jan 01, 2010 this study will be a model for comparative effectiveness using nonrandomized data, permitting extensive assessment of longterm clinical and economic outcomes after coronary revascularization from the largest clinical databases concerning revascularization in the world. Accf national cardiovascular data registry ncdr, we recently completed a comparison of the comparative. Without the dmf, comparative effectiveness or surveillance studies will be delayed, more costly, and, in many instances, infeasible.
However, a 5year study comparing onpump versus offpump bypass surgery. Comparative effectiveness of management strategies for. Comparative effectiveness of management strategies for renal. Padrelated cost effectiveness analysis of the zilver ptx stent relative to other revascularization strategies is also warranted in the future. Comparative effectiveness of coronary artery bypass. Apr 19, 2012 the american college of cardiology foundation accf and the society of thoracic surgeons sts developed a partnership, the accf and sts database collaboration on the comparative effectiveness of revascularization strategies ascert, to compare the outcomes of pci and cabg, using information from records in their respective databases, with. Comparative effectiveness of management strategies for renal artery stenosis. A cost effectiveness analysis of the zilver ptx stent compared to bms use should be performed. Comparative costeffectiveness of surgery, angioplasty, or. This study will be a model for comparative effectiveness using nonrandomized data, permitting extensive assessment of longterm clinical and economic outcomes after coronary revascularization from the largest clinical databases concerning revascularization in the world. The american college of cardiology foundation accf and the society of thoracic surgeons sts developed a partnership, the accf and sts database collaboration on the comparative effectiveness of revascularization strategies ascert, to compare the outcomes of pci and cabg, using information from records in their respective databases.
Comparative effectiveness of diagnostic testing strategies in. Pdf hybrid coronary revascularization hcr involves the integration of coronary artery. Revascularization strategies and outcomes in elderly. Over the past decade, there has been an evolution in imaging research with an everincreasing focus on larger registries and randomized trials comparing the effectiveness of. Why we still need randomized trials to compare effectiveness laura mauri, m. Revascularization strategy ascert longterm sur vival probability calculator is a valuable. Challenges and importance of finding hidden confounders when. Questions persist concerning the comparative effectiveness of percutaneous coronary intervention pci and coronaryartery bypass grafting. The comparative effectiveness of hybrid revascularization midcab then pci with des versus multivessel des pci or cabg hrevs the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Abstractbackgroundascert american college of cardiology foundation and the society of thoracic surgeons collaboration on the comparative effectiveness of revascularization strategies was a large observational study designed to compare the longterm effectiveness of coronary artery bypass graft cabg and percutaneous coronary intervention pci to treat coronary artery disease cad.
Angiographic validation of the american college of. Nov 01, 2016 renal artery stenosis management strategies. The optimal surgical approach, however, remains unclear. Why we still need randomized trials to compare effectiveness. Treatment strategies for patients with peripheral artery disease schuyler jones, md and manesh patel, md july 22, 2015.
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