Document Type : Original Article

Authors

1 Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

2 Cardiovascular Department, Rasoul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Industrial Engineering, Islamic Azad University West Tehran Branch, Tehran, Iran

Abstract

BACKGROUND: The long‑term outcomes are important concepts for cost‑effectiveness analysis
in patients with premature coronary artery disease after revascularization (coronary artery bypass
grafting [CABG] and percutaneous coronary intervention [PCI]) and medical therapy (MT). The
finding of this study will be used to calculate the events probabilities for cost‑effectiveness study.
METHODS AND ANALYSIS: This systematic review will use studies in which patients age must be
18–60 years in eligible studies that obtained from PubMed, Web of Science, Scopus, and Embase.
We will assess the long‑term outcomes after CABG, PCI, and MT by random‑effects meta‑analysis
and effects will be shown by risk ratio. We will ascertain the probabilities of adverse events during
certain periods and then outcomes will compare separately based on specific characteristics.
CONCLUSION: This study will provide information related to outcomes of CABG, PCI, and MT
in patients with premature coronary artery disease. Doing this systematic review is valuable from
clinically and economically aspects such as cost‑effectiveness and cost‑utility analysis.

Keywords

1. Hlatky MA, Boothroyd DB, Bravata DM, Boersma E, Booth J,
Brooks MM, et al. Coronary artery bypass surgery compared
with percutaneous coronary interventions for multivessel disease:
A collaborative analysis of individual patient data from ten
randomised trials. Lancet 2009;373:1190‑7.
2. Maleki M, Alizadehasl A, Haghjoo M. ST‑segment elevation
myocardial infarction. In: Practical Cardiology. Ch. 19.
Philadelphia, PA: Elsevier; 2017. p. 311‑28.
3. Mäkikallio T, Holm NR, Lindsay M, Spence MS, Erglis A,
Menown IB, et al. Percutaneous coronary angioplasty versus
coronary artery bypass grafting in treatment of unprotected left
main stenosis (NOBLE): A prospective, randomised, open‑label,
non‑inferiority trial. Lancet 2016;388:2743‑52.
4. Patterson T, McConkey HZ, Ahmed‑Jushuf F, Moschonas K,
Nguyen H, Karamasis GV, et al. Long‑term outcomes following
heart team revascularization recommendations in complex
coronary artery disease. J Am Heart Assoc 2019;8:e011279.
5. Witberg G, Leviner D, Sharon A, Boulus Y, Sharoni E,
Vaknin‑Assa H, et al. CABG is associated with improved long term
outcomes compared to PCI in patients with premature coronary
artery disease. Eur Heart J 2016;37:475.
6. Khera S, Kolte D, Gupta T, Subramanian KS, Khanna N,
Aronow WS, et al. Temporal trends and sex differences in
revascularization and outcomes of ST‑segment elevation
myocardial infarction in younger adults in the United States.
J Am Coll Cardiol 2015;66:1961‑72.
7. Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA,
et al. Ten‑year outcomes after coronary artery bypass grafting
according to age in patients with heart failure and left ventricular
systolic dysfunction: An analysis of the extended follow‑Up of
the STICH trial (Surgical Treatment for Ischemic Heart Failure).
Circulation 2016;134:1314‑24.
8. Dalén M, Ivert T, Holzmann MJ, Sartipy U. Coronary artery
bypass grafting in patients 50 years or younger: A swedish
nationwide cohort study. Circulation 2015;131:1748‑54.
9. Azar FE, Solhi M, Darabi F, Rohban A, Abolfathi M,
Nejhaddadgar N. Effect of educational intervention based on
PRECEDE‑PROCEED model combined with self‑management
theory on self‑care behaviors in type 2 diabetic patients.
Diabetes Metab Syndr. 2018;12 (6):1075‑8.
10. Sattar N, Rawshani A, Franzén S, Rawshani A, Svensson AM,
Rosengren A, et al. Age at diagnosis of Type 2 diabetes mellitus
and associations with cardiovascular and mortality risks.
Circulation 2019;139:2228‑37.
11. Bittl JA, He Y, Jacobs AK, Yancy CW, Normand SL, American
College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines. Bayesian methods affirm the
use of percutaneous coronary intervention to improve survival
in patients with unprotected left main coronary artery disease.
Circulation 2013;127:2177‑85.
12. Deb S, Wijeysundera HC, Ko DT, Tsubota H, Hill S, Fremes SE.
Coronary artery bypass graft surgery vs percutaneous
interventions in coronary revascularization: A systematic review.
JAMA 2013;310:2086‑95.
13. Fulcher J, Mihaylova B, O’Connell R, Emberson J, Blackwell L,
Reith C, et al. Efficacy and safety of statin therapy in older
people: A meta‑analysis of individual participant data from 28
randomised controlled trials. Lancet 2019;393:407‑15.
14. Simoons ML, Windecker S. Controversies in cardiovascular
medicine: Chronic stable coronary artery disease: Drugs vs.
revascularization. Eur Heart J 2010;31:530‑41.
15. Kirchberger I, Meisinger C, Seidl H, Wende R, Kuch B, Holle R.
Nurse‑based case management for aged patients with myocardial
infarction: Study protocol of a randomized controlled trial. BMC
Geriatr 2010;10:29.
16. Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A,
et al. A systematic review and economic evaluation of statins
for the prevention of coronary events. Health Technol Assess
2007;11:1‑160, iii‑iv.
17. Fearon WF, Bornschein B, Tonino PA, Gothe RM, Bruyne BD,
Pijls NH, et al. Economic evaluation of fractional flow
reserve‑guided percutaneous coronary intervention in patients
with multivessel disease. Circulation 2010;122:2545‑50.
18. Gillespie P, Murphy E, Smith SM, Cupples ME, Byrne M,
Murphy AW. Long‑term cost effectiveness of cardiac secondary
prevention in primary care in the Republic of Ireland and
Northern Ireland. Eur J Health Econ 2017;18:321‑35.
19. Kourlaba G, Gourzoulidis G, Andrikopoulos G, Tsioufis K,
Beletsi A, Maniadakis N. Economic evaluation of trimetazidine in
the management of chronic stable angina in Greece. BMC Health
Serv Res 2016;16:520.
20. Trapero‑Bertran M, Muñoz C, Coyle K, Coyle D, Lester‑George A,
Leidl R, et al. Cost‑effectiveness of alternative smoking cessation
scenarios in Spain: Results from the EQUIPTMOD. Addiction
2018;113 Suppl 1:65‑75.
21. Clement FM, Ghali WA, Rinfret S, Manns BJ, APPROACH
Investigators. Economic evaluation of increasing population
rates of cardiac catheterization. BMC Health Serv Res
2011;11:324.
22. Foglia E, Bonfanti P, Rizzardini G, Bonizzoni E, Restelli U,
Ricci E, et al. Cost‑utility analysis of lopinavir/ritonavir versus
atazanavir+ritonavir administered as first‑line therapy for the
treatment of HIV infection in Italy: From randomised trial to real
world. PLoS One 2013;8:e57777.
23. Lamotte M, Annemans L, Evers T, Kubin M. A multi‑country
economic evaluation of low‑dose aspirin in the primary
prevention of cardiovascular disease. Pharmacoeconomics
2006;24:155‑69.
24. Ennis S, Lobley G, Worrall S, Powell R, Kimani PK, Khan AJ, et al.
Early initiation of post‑sternotomy cardiac rehabilitation exercise
training (SCAR): Study protocol for a randomised controlled trial
and economic evaluation. BMJ Open 2018;8:e019748.
25. Gorenoi V, Schönermark MP, Hagen A. CT coronary angiography
vs. invasive coronary angiography in CHD. GMS Health Technol
Assess 2012;8:Doc02.
26. Oldridge N, Taylor RS. Cost‑effectiveness of exercise therapy
in patients with coronary heart disease, chronic heart failure
and associated risk factors: A systematic review of economic
evaluations of randomized clinical trials. Eur J Prev Cardiol
2020;27:1045‑55.
27. Shrive FM, Manns BJ, Galbraith PD, Knudtson ML, Ghali WA,
APPROACH Investigators. Economic evaluation of
sirolimus‑eluting stents. CMAJ 2005;172:345‑51.
28. Wang D, Cummins C, Bayliss S, Sandercock J, Burls A.
Immunoprophylaxis against respiratory syncytial virus (RSV)
with palivizumab in children: A systematic review and economic
evaluation. Health Technol Assess 2008;12:iii, ix‑x, 1‑86.
29. McEwan P, Bennett H, Ward T, Bergenheim K. Refitting of the
UKPDS 68 risk equations to contemporary routine clinical practice
data in the UK. Pharmacoeconomics 2015;33:149‑61.
30. Murphy S, Raisanen L, Moore G, Edwards RT, Linck P,
Williams N, et al. A pragmatic randomised controlled trial of
the Welsh National Exercise Referral Scheme: Protocol for trial
and integrated economic and process evaluation. BMC Public
Health 2010;10:352.
31. Robertson C, Archibald D, Avenell A, Douglas F, Hoddinott P,
van Teijlingen E, et al. Systematic reviews of and integrated report
on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess
2014;18:v‑vi, xxiii‑xxix, 1‑424.
32. Sharma P, Boyers D, Boachie C, Stewart F, Miedzybrodzka Z,
Simpson W, et al. Elucigene FH20 and LIPOchip for the diagnosis
of familial hypercholesterolaemia: A systematic review and
economic evaluation. Health Technol Assess 2012;16:1‑266.
33. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A,
Petticrew M, et al. Preferred reporting items for systematic review
and meta‑analysis protocols (PRISMA‑P) 2015 statement. Syst
Rev 2015;4:1.
34. Jeffrey A, Iyengar S GJ. Sensitivity analysis and diagnostics. Res
Synth Methods 2009;417:316‑33.
35. Ferdosi M, Vatankhah S, Khalesi N, Ebadi Fard Azar F,
Ayoobian A. Designing a referral system management model
for direct treatment in social security organization. Journal Mil
Med. 2012;14 (2):129‑35.
36. Egger M, Smith GD, Schneider M, Minder C. Bias in meta‑analysis
detected by a simple, graphical test. Bmj 1997;315:629‑34.
37. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S,
et al. Systems for grading the quality of evidence and the
strength of recommendations I: Critical appraisal of existing
approaches The GRADE Working Group. BMC Health Serv
Res 2004;4:38.
38. Azar FE, Asiabar AS. Does leadership effectiveness correlates with
leadership styles in healthcare executives of Iran University of
Medical Sciences. Med J Islam Repub Iran. 2015;29:166.