{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:17:14Z","timestamp":1774538234370,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["212200473"],"award-info":[{"award-number":["212200473"]}],"id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["212200473"],"award-info":[{"award-number":["212200473"]}],"id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["212200473"],"award-info":[{"award-number":["212200473"]}],"id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009192","name":"Alberta Innovates","doi-asserted-by":"publisher","award":["212200473"],"award-info":[{"award-number":["212200473"]}],"id":[{"id":"10.13039\/501100009192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 178027"],"award-info":[{"award-number":["PJT 178027"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 178027"],"award-info":[{"award-number":["PJT 178027"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 178027"],"award-info":[{"award-number":["PJT 178027"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Digit. Med."],"DOI":"10.1038\/s41746-026-02430-x","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T07:35:28Z","timestamp":1771227328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Health economic simulation modeling of an AI-enabled clinical decision support system for coronary revascularization"],"prefix":"10.1038","volume":"9","author":[{"given":"Tom","family":"Mullie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjun","family":"Puri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Bogner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Har","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colm J.","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert C.","family":"Welsh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Tyrrell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher L. F.","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"2430_CR1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(13)60141-5","volume":"381","author":"FW Mohr","year":"2013","unstructured":"Mohr, F. W. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 381, 629\u2013638 (2013).","journal-title":"Lancet"},{"key":"2430_CR2","volume":"15","author":"EA Magnuson","year":"2022","unstructured":"Magnuson, E. A. et al. Cost-effectiveness of percutaneous coronary intervention versus bypass surgery for patients with left main disease: results from the EXCEL trial. Circulation: Cardiovasc. Interventions 15, e011981 (2022).","journal-title":"Circulation: Cardiovasc. Interventions"},{"key":"2430_CR3","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.ahj.2007.10.012","volume":"155","author":"ME Farkouh","year":"2008","unstructured":"Farkouh, M. E. et al. Design of the future revascularization evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM) trial. Am. Heart J. 155, 215\u2013223 (2008).","journal-title":"Am. Heart J."},{"key":"2430_CR4","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1056\/NEJMoa070829","volume":"356","author":"WE Boden","year":"2007","unstructured":"Boden, W. E. et al. Optimal medical therapy with or without PCI for stable coronary disease. N. Engl. J. Med. 356, 1503\u20131516 (2007).","journal-title":"N. Engl. J. Med."},{"key":"2430_CR5","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1016\/S0140-6736(23)00459-2","volume":"401","author":"M Gaudino","year":"2023","unstructured":"Gaudino, M., Andreotti, F. & Kimura, T. Current concepts in coronary artery revascularisation. Lancet 401, 1611\u20131628 (2023).","journal-title":"Lancet"},{"key":"2430_CR6","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1038\/nrcardio.2013.138","volume":"10","author":"J Iqbal","year":"2013","unstructured":"Iqbal, J., Serruys, P. W. & Taggart, D. P. Optimal revascularization for complex coronary artery disease. Nat. Rev. Cardiol. 10, 635\u2013647 (2013).","journal-title":"Nat. Rev. Cardiol."},{"key":"2430_CR7","doi-asserted-by":"publisher","first-page":"2510","DOI":"10.1093\/eurheartj\/eht059","volume":"34","author":"SJ Head","year":"2013","unstructured":"Head, S. J. et al. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur. Heart J. 34, 2510\u20132518 (2013).","journal-title":"Eur. Heart J."},{"key":"2430_CR8","first-page":"5446","volume":"12","author":"LD Scherer","year":"2019","unstructured":"Scherer, L. D. & Fagerlin, A. Shared decision-making in revascularization decisions: complexities and challenges. Circul. Cardiovasc. Qual. Outcomes 12, 5446 (2019).","journal-title":"Circul. Cardiovasc. Qual. Outcomes"},{"key":"2430_CR9","doi-asserted-by":"publisher","first-page":"e26801","DOI":"10.2196\/26801","volume":"10","author":"O Kwon","year":"2022","unstructured":"Kwon, O. et al. Electronic medical record\u2013based machine learning approach to predict the risk of 30-day adverse cardiac events after invasive coronary treatment: machine learning model development and validation. JMIR Med. Inform. 10, e26801 (2022).","journal-title":"JMIR Med. Inform."},{"key":"2430_CR10","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1007\/s10729-020-09522-4","volume":"23","author":"D Bertsimas","year":"2020","unstructured":"Bertsimas, D., Orfanoudaki, A. & Weiner, R. B. Personalized treatment for coronary artery disease patients: a machine learning approach. Health Care Manag Sci. 23, 482\u2013506 (2020).","journal-title":"Health Care Manag Sci."},{"key":"2430_CR11","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/S0140-6736(20)32519-8","volume":"397","author":"F D\u2019Ascenzo","year":"2021","unstructured":"D\u2019Ascenzo, F. et al. Machine learning-based prediction of adverse events following an acute coronary syndrome (PRAISE): a modelling study of pooled datasets. Lancet 397, 199\u2013207 (2021).","journal-title":"Lancet"},{"key":"2430_CR12","doi-asserted-by":"publisher","first-page":"e33395","DOI":"10.2196\/33395","volume":"10","author":"J Wang","year":"2022","unstructured":"Wang, J. et al. Risk prediction of major adverse cardiovascular events occurrence within 6 months after coronary revascularization: machine learning study. JMIR Med. Inform. 10, e33395 (2022).","journal-title":"JMIR Med. Inform."},{"key":"2430_CR13","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/eurheartj\/ehac547","volume":"44","author":"J Lyth","year":"2023","unstructured":"Lyth, J. et al. Cost-effectiveness of population screening for atrial fibrillation: the STROKESTOP study. Eur. Heart J. 44, 196\u2013204 (2023).","journal-title":"Eur. Heart J."},{"key":"2430_CR14","doi-asserted-by":"publisher","first-page":"e65","DOI":"10.1016\/S2468-2667(21)00199-7","volume":"7","author":"G Kaur","year":"2022","unstructured":"Kaur, G. et al. Cost-effectiveness of population-based screening for diabetes and hypertension in India: an economic modelling study. Lancet Public Health 7, e65\u2013e73 (2022).","journal-title":"Lancet Public Health"},{"key":"2430_CR15","doi-asserted-by":"publisher","first-page":"e1446","DOI":"10.1016\/S2214-109X(24)00221-3","volume":"12","author":"A Titan","year":"2024","unstructured":"Titan, A., van, L. et al. Cost-effectiveness and health impact of screening and treatment of Mycobacterium tuberculosis infection among formerly incarcerated individuals in Brazil: a Markov modelling study. Lancet Glob. Health 12, e1446\u2013e1455 (2024).","journal-title":"Lancet Glob. Health"},{"key":"2430_CR16","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1001\/jama.2023.1792","volume":"329","author":"PJ Neumann","year":"2023","unstructured":"Neumann, P. J. & Kim, D. D. Cost-effectiveness thresholds used by study authors, 1990-2021. JAMA 329, 1312\u20131314 (2023).","journal-title":"JAMA"},{"key":"2430_CR17","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/s41746-025-01498-1","volume":"8","author":"P Ghasemi","year":"2025","unstructured":"Ghasemi, P. et al. Personalized decision making for coronary artery disease treatment using offline reinforcement learning. npj Digit. Med. 8, 99 (2025).","journal-title":"npj Digit. Med."},{"key":"2430_CR18","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.jacasi.2023.03.014","volume":"3","author":"PW Serruys","year":"2023","unstructured":"Serruys, P. W. et al. 10 years of SYNTAX. JACC Asia 3, 409\u2013430 (2023).","journal-title":"JACC Asia"},{"key":"2430_CR19","doi-asserted-by":"publisher","first-page":"2375","DOI":"10.1056\/NEJMoa1211585","volume":"367","author":"ME Farkouh","year":"2012","unstructured":"Farkouh, M. E. et al. Strategies for multivessel revascularization in patients with diabetes. N. Engl. J. Med. 367, 2375\u20132384 (2012).","journal-title":"N. Engl. J. Med."},{"key":"2430_CR20","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1056\/NEJMoa1415447","volume":"372","author":"S-J Park","year":"2015","unstructured":"Park, S.-J. et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N. Engl. J. Med 372, 1204\u20131212 (2015).","journal-title":"N. Engl. J. Med"},{"key":"2430_CR21","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/S0140-6736(19)32972-1","volume":"395","author":"NR Holm","year":"2020","unstructured":"Holm, N. R. et al. Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet 395, 191\u2013199 (2020).","journal-title":"Lancet"},{"key":"2430_CR22","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1016\/j.jval.2021.11.1362","volume":"25","author":"MM Voets","year":"2022","unstructured":"Voets, M. M., Veltman, J., Slump, C. H., Siesling, S. & Koffijberg, H. Systematic review of health economic evaluations focused on artificial intelligence in healthcare: the tortoise and the cheetah. Value Health 25, 340\u2013349 (2022).","journal-title":"Value Health"},{"key":"2430_CR23","doi-asserted-by":"publisher","first-page":"e16866","DOI":"10.2196\/16866","volume":"22","author":"J Wolff","year":"2020","unstructured":"Wolff, J., Pauling, J., Keck, A. & Baumbach, J. The economic impact of artificial intelligence in health care: systematic review. J. Med. Internet Res. 22, e16866 (2020).","journal-title":"J. Med. Internet Res."},{"key":"2430_CR24","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jval.2021.08.015","volume":"25","author":"N Hendrix","year":"2022","unstructured":"Hendrix, N., Veenstra, D. L., Cheng, M., Anderson, N. C. & Verguet, S. Assessing the economic value of clinical artificial intelligence: challenges and opportunities. Value Health 25, 331\u2013339 (2022).","journal-title":"Value Health"},{"key":"2430_CR25","unstructured":"Bogner, E. et al. Comprehensive machine learning-enabled outcome prediction for patients with coronary artery disease using multi-center patient data. Can. J. Cardiol. (2025)."},{"key":"2430_CR26","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.ahj.2018.04.011","volume":"201","author":"DJ Maron","year":"2018","unstructured":"Maron, D. J. et al. International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial: rationale and design. Am. Heart J. 201, 124\u2013135 (2018).","journal-title":"Am. Heart J."},{"key":"2430_CR27","first-page":"1225","volume":"16","author":"WA Ghali","year":"2000","unstructured":"Ghali, W. A. & Knudtson, M. L. Overview of the Alberta provincial project for outcome assessment in coronary heart disease. On behalf of the approach investigators. Can. J. Cardiol. 16, 1225\u20131230 (2000).","journal-title":"Can. J. Cardiol."},{"key":"2430_CR28","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1586\/14737167.8.2.165","volume":"8","author":"SD Grosse","year":"2008","unstructured":"Grosse, S. D. Assessing cost-effectiveness in healthcare: history of the $50,000 per QALY threshold. Expert Rev. Pharmacoecon. Outcomes Res. 8, 165\u2013178 (2008).","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"2430_CR29","unstructured":"Government of Canada, S. C. Mortality rates, by age group. https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1310071001 (2021)."},{"key":"2430_CR30","unstructured":"World Bank Open Data. World Bank Open Data https:\/\/data.worldbank.org."},{"key":"2430_CR31","unstructured":"How BLS Measures Price Change for Medical Care Services in the Consumer Price Index. Bureau of Labor Statistics https:\/\/www.bls.gov\/cpi\/factsheets\/medical-care.htm."},{"key":"2430_CR32","unstructured":"International Systematic Review of Utility Values Associated with Cardiovascular Disease and Reflections on Selecting Evidence for a UK Decision-Analytic Model - Rob Hainsworth, Alexander J. Thompson, Bruce Guthrie, Katherine Payne, Gabriel Rogers, 2024. https:\/\/journals.sagepub.com\/doi\/full\/10.1177\/0272989X231214782."},{"key":"2430_CR33","doi-asserted-by":"publisher","first-page":"3113","DOI":"10.1016\/j.jacc.2017.10.036","volume":"70","author":"SJ Baron","year":"2017","unstructured":"Baron, S. J. et al. Quality-of-life after everolimus-eluting stents or bypass surgery for left-main disease. JACC 70, 3113\u20133122 (2017).","journal-title":"JACC"},{"key":"2430_CR34","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1016\/j.jval.2024.05.006","volume":"27","author":"J Elvidge","year":"2024","unstructured":"Elvidge, J. et al. Consolidated health economic evaluation reporting standards for interventions that use artificial intelligence (CHEERS-AI). Value Health 27, 1196\u20131205 (2024).","journal-title":"Value Health"}],"container-title":["npj Digital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02430-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02430-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02430-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:22:02Z","timestamp":1774534922000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41746-026-02430-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,16]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2430"],"URL":"https:\/\/doi.org\/10.1038\/s41746-026-02430-x","relation":{},"ISSN":["2398-6352"],"issn-type":[{"value":"2398-6352","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,16]]},"assertion":[{"value":"9 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A.P. and J.L. are co-founders and major shareholders of Symbiotic AI, Inc. B.H. and C.J.M. are minor shareholders of Symbiotic AI, Inc. All other authors have no conflict of interest to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"249"}}