Excerpt

Percutaneous coronary interventions (PCI) with or without stents and coronary artery bypass graft surgery (CABG) are the two broad categories of interventions for mechanical revascularization of atherosclerotic coronary arteries in patients with coronary artery disease (CAD). Generally, both approaches would be clinically relevant for patients with single-vessel disease of the proximal left anterior descending artery, most types of two-vessel disease, as well as for patients with three-vessel disease that is not particularly extensive. Because PCI and CABG differ in their procedural risk and their initial and downstream costs, assessing their comparative effectiveness and safety is of great interest.

PCI and CABG have already been compared in several randomized controlled trials (RCTs) and analyses of large clinical registries. The aim of this report is to identify needs for future research in the comparison between PCI and CABG. We use as a basis the 2007 comparative effectiveness review (CER) by the Stanford–University of California at San Francisco Evidence-based Practice Center (Stanford–UCSF EPC) that assessed PCI vs. CABG for coronary artery disease (hereafter we refer to the report as the “Stanford CER” for brevity). The CER summarized evidence published through 2006.

Contents

• Preface
• Executive Summary
  • Background
  • Methods
  • Results
  • Conclusions
• Background
  • Findings of the Stanford CER
  • Currency of the Stanford Report
  • Research Gaps Identified in the Stanford CER
• Methods
  • Overview of the Stepwise Approach
  • Step 1 Generating the Initial List of Evidence Gaps
  • Step 2 Generating the Expanded List of Evidence Gaps
  • Step 3 Generating the Final List of Important Evidence Gaps
  • Step 4 Making Recommendations for Future Research
  • Handling Conflicts of Interest
• Results
  • Step 1 Generating the Initial List of Evidence Gaps
  • Step 2 Generating the Expanded List of Evidence Gaps
  • Step 3 Generating the Final List of Important Evidence Gaps
  • Step 4 Recommendations for Future Research
• Discussion
  • Key Informants
  • Quantitative Analyses Based on Simple Models
  • The Implications of an Incomplete “Intervention Space” in the Decisional Context
• Conclusion
• References
• Abbreviations
• Appendixes
  • Appendix A Search Strategies
  • Appendix B Search Prioritization Tools
  • Appendix C Excluded Studies
  • Appendix D Methods and Results of Quantitative Analyses

AHRQ Contacts: Carolyn M Clancy, MD, Director, Agency for Healthcare Research and Quality; Stephanie Chang, MD, MPH, Director, Evidence-based Practice Center Program, Agency for Healthcare Research and Quality; Jean Slutsky, PA, MSPH, Director, Center for Outcomes and Evidence, Agency for Healthcare Research and Quality; Elisabeth U Kato, MD, MRP, Task Order Officer, Evidence-based Practice Center Program, Agency for Healthcare Research and Quality

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Contract No. 290-2007-10055-I. Prepared by: Tufts Evidence-based Practice Center, Boston, MA

Suggested citation:

Trikalinos TA, Dahabreh IJ, Wong J, Rao M. Future Research Needs for the Comparison of Percutaneous Coronary Interventions with Bypass Graft Surgery in Nonacute Coronary Artery Disease. Future Research Needs Paper No. 1. (Prepared by the Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I.) AHRQ Publication No. 10-EHC068-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2010. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Tufts Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10055-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

This report may be used, in whole or in part, as the basis for research design or funding opportunity announcements. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

This information does not represent and should not be construed to represent a determination or policy of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov