Abstract:
BACKGROUND:The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial demonstrated that in patients with 3-vessel or left main coronary artery disease, coronary artery bypass graft surgery (CABG) was associated with a lower rate of cardiovascular death, myocardial infarction, stroke, or repeat revascularization compared with percutaneous coronary revascularization with drug-eluting stents (DES-PCI)). The long-term cost-effectiveness of these strategies is unknown. METHODS AND RESULTS:Between 2005 and 2007, 1800 patients with left main or 3-vessel coronary artery disease were randomized to CABG (n=897) or DES-PCI (n=903). Costs were assessed from a US perspective, and health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on the 5-year in-trial data was used to extrapolate costs, life expectancy, and quality-adjusted life expectancy over a lifetime horizon. Although initial procedural costs were $3415 per patient lower with CABG, total hospitalization costs were $10 036 per patient higher. Over the next 5 years, follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations, revascularization procedures, and higher medication costs. Over a lifetime horizon, CABG remained more costly than DES-PCI, but the incremental cost-effectiveness ratio was favorable ($16 537 per quality-adjusted life-year gained) and remained <$20 000 per quality-adjusted life-year in most bootstrap replicates. Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs. In patients with left main disease or a SYNTAX score ≤22, however, DES-PCI was economically dominant compared with CABG, although these findings were less certain. CONCLUSIONS:For most patients with 3-vessel or left main coronary artery disease, CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI. However, among patients with less complex disease, DES-PCI may be preferred on both clinical and economic grounds. CLINICAL TRIAL REGISTRATION URL:www.clinicaltrials.gov. Unique identifier: NCT00114972.
journal_name
Circulationjournal_title
Circulationauthors
Cohen DJ,Osnabrugge RL,Magnuson EA,Wang K,Li H,Chinnakondepalli K,Pinto D,Abdallah MS,Vilain KA,Morice MC,Dawkins KD,Kappetein AP,Mohr FW,Serruys PW,SYNTAX Trial Investigators.doi
10.1161/CIRCULATIONAHA.114.009985subject
Has Abstractpub_date
2014-09-30 00:00:00pages
1146-57issue
14eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.114.009985journal_volume
130pub_type
杂志文章,随机对照试验相关文献
CIRCULATION文献大全abstract:BACKGROUND:We tested the hypothesis that real-time magnetic resonance imaging (MRI) can guide coronary artery catheterization in swine via a percutaneous femoral artery approach. METHODS AND RESULTS:In 12 pigs, we accessed femoral arteries percutaneously. We used 6- or 7-French coronary Judkins catheters filled with d...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000074776.88681.F5
更新日期:2003-06-03 00:00:00
abstract::Inherited thoracic aortopathies denote a group of congenital conditions that predispose to disease of the thoracic aorta. Aortic wall weakness and abnormal aortic hemodynamic profiles predispose these patients to dilatation of the thoracic aorta, which is generally silent but can precipitate aortic dissection or ruptu...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.043756
更新日期:2020-05-12 00:00:00
abstract:BACKGROUND:Controversy exists as to whether low-osmolality radiographic contrast agents, which have less detrimental pharmacological effects but are considerably more expensive than high-osmolality agents, should be used universally or only for selected high-risk patients. METHODS AND RESULTS:A randomized, double-blin...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.89.1.291
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement. METHODS AND RESULTS:A matched study was performed using prospectively collected data from the Emory cardiovascular databas...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000079169.15862.13
更新日期:2003-07-22 00:00:00
abstract::Echocardiographic measurements of the left ventricle were used to define rates of circumferential fiber lengthening at the endocardium and midwall in 12 normal subjects and six patients with concentric left ventricular hypertrophy (wall thickness 11 to 16 mm). There was no difference in chamber size and systolic short...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract:BACKGROUND:The purpose of this investigation was to establish normal values of RR variability for middle-aged persons and compare them with values found in patients early and late after myocardial infarction. We hypothesized that presence or absence of coronary heart disease, age, and sex (in this order of importance) ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1161/01.cir.91.7.1936
更新日期:1995-04-01 00:00:00
abstract::The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left a...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.66.5.1065
更新日期:1982-11-01 00:00:00
abstract:BACKGROUND:Long-term comparative data of first-generation drug-eluting stents are scarce. We investigated clinical and angiographic outcomes of sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) at 5 years as part of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization (SIRTAX)...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.110.004762
更新日期:2011-06-21 00:00:00
abstract:BACKGROUND:The T2G1s monoclonal antifibrin antibody binds specifically to fibrin but not to fibrinogen. METHODS AND RESULTS:In a canine model of acute arterial thrombosis, we determined the feasibility of imaging thrombi using a 99mTc-labeled Fab' fragment. In 14 dogs, 10 carotid and 13 femoral artery thrombi were pro...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.85.1.298
更新日期:1992-01-01 00:00:00
abstract::Contracture and collapse often complicate dissection and excision of blood vessels for grafting. Subsequent forceful redilatation and leak checking with cold saline almost always lead to partial or total denudation of endothelium, which increases the risk of early occlusion by thrombi or late occlusion by fibrocellula...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1981-08-01 00:00:00
abstract:BACKGROUND:Aortic valve calcification is an actively regulated process that displays hallmarks of atherosclerosis. Natriuretic peptides (A-, B-, and C-type natriuretic peptides [ANP, BNP, and CNP]) have been reported to have a role in the pathogenesis of vascular atherosclerosis, but their expression in aortic valves i...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.685743
更新日期:2007-09-11 00:00:00
abstract::Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous d...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.118.034075
更新日期:2019-09-10 00:00:00
abstract:BACKGROUND:High C-reactive protein (CRP) levels are associated with an increased risk of cardiovascular events, even in apparently healthy individuals. It has not been established whether elevated CRP reflects an increased burden of subclinical coronary atherosclerosis. METHODS AND RESULTS:We studied a stratified rand...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000032135.98011.c4
更新日期:2002-09-03 00:00:00
abstract::South Asians (from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) make up one quarter of the world's population and are one of the fastest-growing ethnic groups in the United States. Although native South Asians share genetic and cultural risk factors with South Asians abroad, South Asians in...
journal_title:Circulation
pub_type: 杂志文章,实务指引,评审
doi:10.1161/CIR.0000000000000580
更新日期:2018-07-03 00:00:00
abstract::Although the resting hemodynamic effects of captopril in congestive heart failure are known, little information is available about the hemodynamic response to captopril during exercise or about changes in noninvasive measurements of the size and function of both ventricles. In this study, 14 stable New York Heart Asso...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.65.7.1374
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:Drugs that simultaneously decrease platelet function and inflammation may improve the treatment of cardiovascular disorders. Here, we determined whether dipyridamole and aspirin, a combination therapy used to prevent recurrent stroke, regulates gene expression in platelet-monocyte inflammatory model systems....
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000154607.90506.45
更新日期:2005-02-08 00:00:00
abstract:BACKGROUND:Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. METH...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/CIRCULATIONAHA.105.593210
更新日期:2006-08-15 00:00:00
abstract:BACKGROUND:Beta-blockers improve clinical outcome when administered early after acute myocardial infarction. However, whether beta-blockers actually reduce the myocardial infarction size is still in dispute. Cardiac magnetic resonance imaging can accurately depict the left ventricular (LV) ischemic myocardium at risk (...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.679639
更新日期:2007-06-12 00:00:00
abstract:BACKGROUND:Visceral adiposity is generally considered to play a key role in the metabolic syndrome, including hypertension. The purpose of this study was to evaluate cross-sectionally whether visceral adiposity is associated with prevalence of hypertension independent of other adipose depots and fasting plasma insulin....
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000087597.59169.8D
更新日期:2003-10-07 00:00:00
abstract:BACKGROUND:Impaired fibrinolytic activity has been linked to the presence and severity of allograft vasculopathy (Tx CAD). This impairment may be associated with the presence of certain fibrinolytic protein gene polymorphisms. METHODS AND RESULTS:To investigate the relation between donor-specific fibrinolytic protein ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.98.21.2248
更新日期:1998-11-24 00:00:00
abstract:BACKGROUND:Long-term beta-adrenergic blockade does not appear to be associated with drug-induced training in patients with congestive heart failure (CHF); whether exercise training can increase peak aerobic capacity in patients with CHF who are treated with beta-adrenergic blockers is currently unknown. METHODS AND RE...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.95.7.1764
更新日期:1997-04-01 00:00:00
abstract::Increased ventricular volume is one of the most powerful predictors of reduced survival in patients with heart disease. Despite its well-documented prognostic significance, the magnitude of the progression of ventricular dilatation from the acute to the chronic phase of myocardial infarction has only recently been app...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:
更新日期:1987-05-01 00:00:00
abstract:BACKGROUND:Transplantation of ex vivo expanded circulating endothelial progenitor cells (EPCs) from peripheral blood mononuclear cells improves the neovascularization after critical ischemia. However, the origin of the endothelial progenitor lineage and its characteristics have not yet been clearly defined. Therefore, ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000096483.29777.50
更新日期:2003-11-18 00:00:00
abstract:BACKGROUND:The role of a cluster of risk factors characteristic for the insulin resistance syndrome as a predictor for coronary heart disease (CHD) has not been studied previously. METHODS AND RESULTS:Clustering of cardiovascular risk factors was analyzed by factor analysis to investigate whether these clusters (facto...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.2.123
更新日期:1999-07-13 00:00:00
abstract::Left ventricular function was compared in 18 normal sedentary controls (mean age 28 years, range 22 - 34 years) and nine endurance-trained athletes (mean age 19 years, range 15 - 25 years) at rest and during supine bicycle exercise. Gated radionuclide angiocardiograms were performed at rest and at each level of graded...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.65.3.484
更新日期:1982-03-01 00:00:00
abstract::The evidence supporting the thesis that hypertension can be prevented by eliminating salt from the diet is based on four principal sources: (1) epidemiological studies in unacculturated peoples showing that the prevalence of hypertension is inversely correlated with the degree of salt intake; (2) hemodynamic studies s...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.cir.53.4.589
更新日期:1976-04-01 00:00:00
abstract::Recent studies have shown that blood flow during closed-chest cardiopulmonary resuscitation (CPR) results primarily from generalized changes in intrathoracic pressure rather than direct compression of the heart. Since ascending aortic and right atrial pressures rise and fall synchronously and to comparable levels duri...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.66.2.297
更新日期:1982-08-01 00:00:00
abstract:BACKGROUND:Depletion of L-arginine (L-arg), the substrate for nitric oxide (NO) synthesis, could be one of the mechanisms responsible for the reduced production of NO and decreased coronary flow (CF) during reperfusion. This, in turn, may adversely affect mechanical function. We aimed to study the benefits of exogenous...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1997-11-04 00:00:00
abstract:BACKGROUND:Accumulating evidence suggests that several subsets of regulatory T cells that actively mediate immunologic tolerance play crucial roles in atherogenesis. Recently, orally administered anti-CD3 monoclonal antibody has been shown as an inducer of novel regulatory T cells expressing latency-associated peptide ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.109.863431
更新日期:2009-11-17 00:00:00
abstract:BACKGROUND:The pathobiological basis of ischemic heart disease and thus the manifestations and response to therapy can differ between women and men. In prior studies, sex-based treatment differences have been observed with the antiischemic ranolazine, with a possibly diminished effect in women. METHODS AND RESULTS:We ...
journal_title:Circulation
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCULATIONAHA.109.897231
更新日期:2010-04-27 00:00:00