TRIP

Patient Priorities Differ from Research Agenda (CME/CE)

MedPageToday, 2012

, for example, the composite endpoint included death, stroke, nonfatal myocardial infarction (MI), and target vessel revascularization (TVR), Peter K.
Smith, MD, from Duke University Medical Center, explained at the annual meeting of the Society of Thoracic Surgeons.
If a patient experienced any one of them, it counted toward the major adverse cardiac and cerebrovascular events (MACCE) rate.
But if those individual components do not carry equal importance to patients, any data that rely on this assumption could be faulty, Smith said.
So he and his colleagues surveyed 244 people (62% men) to see whether they would rank some of the components of the SYNTAX composite higher than others if deciding between coronary artery bypass grafting (CABG) and stenting.
They also asked about two non-MACCE factors that might impact one's choice: extent of procedure, hospitalization, and recovery time; and potential for increased longevity.
The patients, it turned out, were far more concerned about the risk of death than any other outcome, giving it a relative weight of 0.23.
Stroke came in second (relative weight 0.18) and even long-term outcome and recovery time (each 0.17) counted more than MI or TVR.
In fact, the composite factor that least concerned those surveyed was TVR (relative weight 0.11), even though the number of TVRs in the SYNTAX trial -- which found coronary artery bypass grafting (CABG) superior to stenting -- propelled its high MACCE rate, Smith, told MedPage Today .
Despite the positive results for CABG, many people focused on the higher rate of stroke associated with CABG and concluded that percutaneous coronary intervention (PCI) was equally as good.
The survey was an online questionnaire, and the scenario presented would make respondents eligible for the SYNTAX three-vessel disease cohort.