Risk-benefit analysis
Summary
During the past 30 years, percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) have been compared in order to identify the optimal revascularisation technique for multivessel coronary artery disease. All trials have shown that both CABG and PCI increase health-related quality of life (HRQL), with greater short-term benefits seen with PCI. The transition from balloon angioplasty, done without stents (subsequently referred to as “plain old balloon angioplasty” or POBA), to bare metal and drug-eluting stent use have progressively reduced the differences between PCI and CABG in terms of risk of repeat procedures. Since a key goal of treating patients with ischaemia is to restore a normal life for the patient as quickly as possible, risk-benefit models have evolved to provide an additional perspective for procedural choice. Risk-benefit modelling can be used to demonstrate the trade-off that physicians and patients face in choosing between the deferred benefits of reduced rates of repeat revascularisation from CABG versus delayed relief from pain or improvements in HRQL. The same modelling may be applied to high-risk patients who undergo transcatheter aortic valve replacement (TAVR). This chapter describes standard benefit measures, reviews results from randomised trials, describes how a risk-benefit model enables comparisons...
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