Original Studies Economic Outcomes of Percutaneous Coronary Intervention with Drug-Eluting Stents versus Bypass Surgery for Patients with Left Main or Three-Vessel Coronary Artery Disease: One-Year Results from the

Objectives: To evaluate the cost-effectiveness of alternative approaches to revasculari-zation for patients with three-vessel or left main coronary artery disease (CAD). Background: Previous studies have demonstrated that, despite higher initial costs, long-term costs with bypass surgery (CABG) in multivessel CAD are similar to those for percutaneous coronary intervention (PCI). The impact of drug-eluting stents (DES) on these results is unknown. Methods: The SYNTAX trial randomized 1,800 patients with left main or three-vessel CAD to either CABG (n 5 897) or PCI using paclitaxel-eluting stents (n 5 903). Resource utilization data were collected prospectively for all patients, and cumulative 1-year costs were assessed from the perspective of the U.S. healthcare system. Results: Total costs for the initial hospitalization were $5,693/ patient higher with CABG, whereas follow-up costs were $2,282/patient higher with PCI due mainly to more frequent revascularization procedures and higher outpatient medication costs. Total 1-year costs were thus $3,590/patient higher with CABG, while quality-adjusted life expectancy was slightly higher with PCI. Although PCI was an Additional Supporting Information may be found in the online versio