{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T09:16:06Z","timestamp":1785575766437,"version":"3.56.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,4,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Coronary revascularization provides important long\u2010term clinical benefits to patients with high\u2010risk presentations of coronary artery disease, including those with chronic kidney disease. The cost\u2010effectiveness of coronary interventions in this setting is not known.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We developed a Markov cohort simulation model to assess the cost\u2010effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease who were hospitalized with acute myocardial infarction or unstable angina. Model inputs were primarily drawn from a sample of 14\u00a0300 patients identified using the Medicare 20% sample. Survival, quality\u2010adjusted life\u2010years, costs, and cost\u2010effectiveness were projected over a 20\u2010year time horizon. Multivariable models indicated higher 30\u2010day mortality and end\u2010stage renal disease with both PCI and CABG, and higher stroke with CABG, relative to medical therapy. However, the model projected long\u2010term gains of 0.72 quality\u2010adjusted life\u2010years (0.97 life\u2010years) for PCI compared with medical therapy, and 0.93 quality\u2010adjusted life\u2010years (1.32 life\u2010years) for CABG compared with PCI. Incorporation of long\u2010term costs resulted in incremental cost\u2010effectiveness ratios of $65\u00a0326 per quality\u2010adjusted life\u2010year gained for PCI versus medical therapy, and $101\u00a0565 for CABG versus PCI. Results were robust to changes in input parameters but strongly influenced by the background costs of the population, and the time horizon.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">For patients with chronic kidney disease and high\u2010risk coronary artery disease presentations, PCI and CABG were both associated with markedly increased costs as well as gains in quality\u2010adjusted life expectancy, with incremental cost\u2010effectiveness ratios indicating intermediate value in health economic terms.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019391","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T10:19:55Z","timestamp":1617185995000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Cost\u2010Effectiveness of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease and Acute Coronary Syndromes in the US Medicare Program"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8675-8186","authenticated-orcid":false,"given":"Matthew R.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Lahey Hospital &amp; Medical Center Burlington MA"},{"name":"Baim Institute for Clinical Research Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Gong","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group Hennepin Healthcare Research Institute Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuling","family":"Li","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group Hennepin Healthcare Research Institute Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0387-8412","authenticated-orcid":false,"given":"Charles A.","family":"Herzog","sequence":"additional","affiliation":[{"name":"Chronic Disease Research Group Hennepin Healthcare Research Institute Minneapolis MN"},{"name":"Department of Medicine Hennepin Healthcare and University of Minnesota Minneapolis MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Charytan","sequence":"additional","affiliation":[{"name":"NYU Langone Medical Center New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041365"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041031"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq328"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ASN.0000135969.33773.0B"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070829"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915922"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915925"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200106213442501"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)07349-3"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.04.018"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9301300409"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12195"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.005355"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.1938"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003407"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.07.017"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001307"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2016.07.024"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.4566"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a9f45f"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc5001.100794"},{"key":"e_1_3_1_23_2","volume-title":"Unites States life tables, 2017. 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