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Topic Title

  • Future Research Needs for the Comparison of Percutaneous Coronary Interventions With Bypass Graft Surgery in Nonacute Coronary Artery Disease

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Future Research Needs Projects

Future Research Needs - Methods Research Series

Abstract - Final – Sept. 13, 2010

Future Research Needs: Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Patients with Coronary Artery Disease

Topic Abstract

Background: Percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are two alternative interventions for the treatment of patients with single or multi-vessel coronary artery disease. Both procedures revascularize the hemodynamically compromised heart and have been compared in several randomized controlled trials and in analyses of large observational databases. A 2007 CER produced by the Stanford EPC provides a recent comprehensive summary of the published evidence through 2006 and addresses important questions such the comparative effectiveness (harms and benefits) of each approach, duration of benefit, and the effect of patient and procedure related variables on outcomes.1 The Stanford CER also identified several gaps in the evidence base; however, the identification of gaps is narrowly defined, and the resulting gaps are not prioritized or translated into research needs.

Objective: The objective of this pilot project is to prioritize a list of research questions to address research gaps related to the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass grafting for patients with coronary artery disease. The project will also explore the added value of progressively more quantitative approaches to prioritization.

Approach: Our approach will be to prioritize research needs in an iterative fashion. Preliminary assessments from the EPC and its experts will be discussed with key informants, and the feedback used to refine the decisional context, i.e., the description of patients, comparisons, perspective and time horizon of interest. There is a natural continuum of steps: The first step is to obtain a list of qualitatively ranked research needs, based on a discussion of methodological, epidemiological and clinical considerations, but not on formal quantitative analyses. After further refinement of the dimensions of the decisional context, we will utilize quantitative methods that are based on decision modeling, cost-effectiveness modeling and value of information analyses. Research needs ranked by decision analysis, research needs ranked by cost-effectiveness analysis, and (time permitting) research needs from value of information analyses would be the products of the quantitative methods.

1 Bravata DM, McDonald KM, Gienger AL, Sundaram V, Perez MV, Varghese R, Kapoor JR, Ardehali R, McKinnon MC, Stave CD, Owens DK, Hlatky MA. Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease. Comparative Effectiveness Review No. 9. (Prepared by Stanford-UCSF Evidence-based Practice Center under Contract No. 290-02-0017.) Rockville, MD: Agency for Healthcare Research and Quality. October 2007.