Patients' Preferences after Recurrent Coronary Narrowing: Discrete Choice Experiments

Abstract Background: Selecting the optimal treatment strategy for coronary revascularization is challenging. A crucial endpoint to be considered when making this choice is the necessity to repeat revascularization since it is much more frequent after percutaneous coronary intervention (PCI) than after coronary artery bypass grafting (CABG). Objective: This study intends to provide insights on patients' preferences for revascularization, strategies in the perspective of patients who had to repeat revascularization. Methods: We selected a sample of patients who had undergone PCI and were hospitalized to repeat coronary revascularization and elicited their preferences for a new PCI or CABG. Perioperative death, long-term death, myocardial infarction, and repeat revascularization were used to design scenarios describing hypothetical treatments that were labeled as PCI or CABG. PCI was always presented as the option with lower perioperative death risk and a higher necessity to repeat procedure. A conditional logit model was used to analyze patients' choices using R software. A p value < 0.05 was considered statistically significant. Results: A total of 144 patients participated, most of them (73.7%) preferred CABG over PCI (p < 0.001). The regression coefficients were statistically significant for PCI label, PCI long-term death, CABG perioperative death, CABG long-term death and repeat CABG. The PCI label was the most important parameter (p < 0.05). Conclusion: Most patients who face the necessity to repeat coronary revascularization reject a new PCI, considering realistic levels of risks and benefits. Incorporating patients' preferences into benefit-risk calculation and treatment recommendations could enhance patient-centered care.

背景：为冠状动脉血运重建选择最优治疗策略颇具挑战性。制定该治疗决策时需重点考量的关键终点为重复血运重建的必要性——经皮冠状动脉介入治疗（PCI）后重复血运重建的发生率远高于冠状动脉旁路移植术（CABG）。
目的：本研究旨在从需接受重复血运重建的患者视角出发，探析其对血运重建策略的偏好。
方法：本研究纳入曾接受经皮冠状动脉介入治疗（PCI）且因需重复冠状动脉血运重建入院的患者样本，征集其对再次行PCI或冠状动脉旁路移植术（CABG）的偏好。研究以围术期死亡、长期死亡、心肌梗死及重复血运重建为维度设计模拟治疗场景，并将各场景分别标记为PCI或CABG方案。其中，PCI方案始终被设定为围术期死亡风险更低但需再次接受手术的概率更高的选项。本研究采用条件logit模型（conditional logit model）结合R软件对患者的选择行为进行分析，以P值<0.05作为具有统计学显著性的判定标准。
结果：本研究共纳入144例患者，其中73.7%的受试者更偏好CABG而非PCI（P<0.001）。PCI标记、PCI长期死亡风险、CABG围术期死亡风险、CABG长期死亡风险及重复CABG对应的回归系数均具有统计学显著性，其中PCI标记为最具影响力的参数（P<0.05）。
结论：在考量真实风险与获益水平的前提下，多数需接受重复冠状动脉血运重建的患者会拒绝再次行PCI。将患者偏好纳入获益-风险评估及治疗推荐流程，可助力提升以患者为中心的诊疗质量。