Five-year economic and quality of life outcomes favor PCI with zotarolimus stents over CABG in 3-vessel CAD

This randomized trial evaluated patients with 3-vessel coronary artery disease. The study population included 1,500 patients. The setting details were not reported. The intervention involved fractional flow reserve-guided percutaneous coronary intervention using zotarolimus drug-eluting stents. The comparator was coronary artery bypass grafting. The primary outcomes assessed were economic and quality of life outcomes over a five-year follow-up period.

The primary outcome measured cumulative costs over five years. Patients assigned to CABG incurred costs that were 30% higher than those in the PCI group. The 95% confidence interval for this difference was 16% to 46%. The p-value was less than 0.001. This indicates a statistically significant difference in economic burden favoring the PCI strategy.

Quality-adjusted life years over five years did not differ significantly between the two groups. The absolute numbers reported were 4.05 plus or minus 0.84 for PCI and 4.03 plus or minus 0.82 for CABG. No p-value or confidence interval was reported for this specific comparison, but the direction was no significant difference.

EQ-5D scores improved more rapidly after PCI compared to CABG. The specific rates of improvement were not numerically detailed in the results provided. Employment status at five years was assessed in patients under 65 years old. The PCI group had an employment rate of 56%, while the CABG group had a rate of 47%. The p-value for this difference was 0.025.

Economic value replications indicated that PCI had greater economic value than CABG. In 66% of replications, PCI demonstrated lower costs and higher QALYs. Incremental cost-effectiveness ratios for CABG were found to be above the $150,000 per QALY benchmark. This threshold was exceeded in 98% of bootstrap replications.

Safety and tolerability findings were not reported in the provided data. Adverse events, serious adverse events, discontinuations, and general tolerability were not reported. The study limitations were not reported. Funding or conflicts of interest were not reported. Causality notes and certainty notes were not reported.

These results suggest that PCI with zotarolimus stents may provide economic benefits over CABG for selected patients with 3-vessel disease. The lack of significant difference in QALYs supports the economic advantage of PCI. However, the absence of reported safety data limits the ability to fully assess the risk-benefit profile. Questions remain regarding long-term durability and safety in broader populations. Clinical decisions should weigh these economic findings against individual patient risk factors and preferences.