Combining Patient Clustering and Quantitative Benefit-Risk Assessment in the Comparison of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention
Author(s)
XUAN ZHANG, MD PhD PhD, Lejia Hu, MS, Hal Yapici, MBA, MPH, MD, Kunal J. Lodaya, MD, Sibyl H. Munson, PhD, Fabian Thomas William D'Souza, MD, MSurg, FRCS, MBA, Weiqi Jiao, ScM, Hayden W. Hyatt, PhD, Rahul Rajkumar, MD, MPH, Nicholas Bettencourt, BS.
Boston Strategic Partners, Inc., Boston, MA, USA.
Boston Strategic Partners, Inc., Boston, MA, USA.
Presentation Documents
OBJECTIVES: The optimal treatment for coronary artery disease (CAD) remains debated, with percutaneous coronary intervention (PCI) often compared to coronary artery bypass grafting (CABG), the gold standard. This study aims to assess the benefit-risk balance of these procedures by integrating real-world data and patient preferences.
METHODS: The National COVID Cohort Collaborative (N3C) database was used to identify CAD patients who underwent CABG or PCI from 2017 to 2021. To better understand the comparisons depending on patient characteristics, analyses were performed separately on two patient clusters derived from the K-means algorithm. Propensity score matching was used to align patients’ age, gender, year of surgery, acute coronary insufficiency (CI), EuroScore II, and region in the two groups for each cluster. The quantitative Benefit-Risk Assessment (qBRA) framework guided the study design, focusing on endpoints including rates of 3-year mortality, stroke, myocardial infarction, revascularization, and extended hospital stays (top 25%), with corresponding weights of 0.32, 0.25, 0.20, 0.15, and 0.08. Discrete choice experiments quantified patient preferences, deriving weights for outcome variables.
RESULTS: The two patient clusters differed significantly in baseline demographics and characteristics. Cluster A (n=3,457) included healthier patients (lower acute CI rates, lower EuroScore II, and earlier treatment dates), who were less likely to reside in the Midwest or South as compared to cluster B (n=6,103). Despite these differences, both clusters favored CABG in aggregated scores (0.26 in cluster A and 0.22 in cluster B), with a stronger preference in cluster A. While the PCI group had fewer extended hospital stays, the two procedures showed minimal differences in revascularization rates. CABG outperformed PCI in 3-year mortality, stroke, and MI.
CONCLUSIONS: Using the qBRA framework, this study highlights that CABG offers superior outcomes compared to PCI among CAD patients. By incorporating patient preferences, qBRA provides a valuable tool for aligning clinical decisions with patient-centric perspectives.
METHODS: The National COVID Cohort Collaborative (N3C) database was used to identify CAD patients who underwent CABG or PCI from 2017 to 2021. To better understand the comparisons depending on patient characteristics, analyses were performed separately on two patient clusters derived from the K-means algorithm. Propensity score matching was used to align patients’ age, gender, year of surgery, acute coronary insufficiency (CI), EuroScore II, and region in the two groups for each cluster. The quantitative Benefit-Risk Assessment (qBRA) framework guided the study design, focusing on endpoints including rates of 3-year mortality, stroke, myocardial infarction, revascularization, and extended hospital stays (top 25%), with corresponding weights of 0.32, 0.25, 0.20, 0.15, and 0.08. Discrete choice experiments quantified patient preferences, deriving weights for outcome variables.
RESULTS: The two patient clusters differed significantly in baseline demographics and characteristics. Cluster A (n=3,457) included healthier patients (lower acute CI rates, lower EuroScore II, and earlier treatment dates), who were less likely to reside in the Midwest or South as compared to cluster B (n=6,103). Despite these differences, both clusters favored CABG in aggregated scores (0.26 in cluster A and 0.22 in cluster B), with a stronger preference in cluster A. While the PCI group had fewer extended hospital stays, the two procedures showed minimal differences in revascularization rates. CABG outperformed PCI in 3-year mortality, stroke, and MI.
CONCLUSIONS: Using the qBRA framework, this study highlights that CABG offers superior outcomes compared to PCI among CAD patients. By incorporating patient preferences, qBRA provides a valuable tool for aligning clinical decisions with patient-centric perspectives.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO69
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment, Comparative Effectiveness or Efficacy, Performance-based Outcomes
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)