List 3Pruned (final) list of important evidence gaps

Thematic areaList of evidence gaps
Thematic area 1: Comparative effectiveness of PCI vs. CABGPopulations:
  • Age >75 years
  • Prior PCI
  • Diabetes
  • Women
  • Congestive heart failure
  • Stage 3 or 4 of chronic kidney disease
Interventions:
  • PCI: Bare metal stents
  • PCI: Drug eluting stents
  • CABG: On pump traditional CABG with arterial grafts
Outcomes:
  • 30-day outcomes -objective:
    • Periprocedural death
    • Nonfatal MI
    • Nonfatal stroke
    • Unplanned urgent revascularization with CABG during the PCI
    • Renal failure requiring renal replacement therapy
    • Post procedural discharge to rehabilitation facilities
    • Health care costs
    • Readmission rates for cardiac reasons such as heart failure and unstable angina
    • Others like nosocomial infections are most relevant to CABG, and pulmonary complications affect the length of stay
  • Intermediate outcomes (objective) at 1 year. The relative ranking would be similar to the applicable 30 day outcomes.
  • Longer term outcomes (objective) would be 5 years. The relative ranking would be similar to the applicable 30 day outcomes.
  • Subjective outcomes:
    • QoL is very important and can be measured by generic or disease-specific instruments
Thematic area 2: Testing to inform choice of revascularization procedureThe evidence gap pertains to whether testing before revascularization can guide the choice of revascularization procedure, e.g., by predicting clinical response in the long term. Examples of invasive and non-invasive tests:
  • Invasive coronary arteriography
  • Non-invasive CT angiography or MR angiography
  • Resting or exercise SPECT
  • Exercise treadmill test with or without echocardiography
Thematic area 3: Enhancing patient participation
  • Eliciting and measuring patient preferences
  • Facilitating shared decisionmaking between patients and their physicians by developing and then evaluating decision support tools.
Thematic area 4: Assessing performance
  • Based on prior key informant input, there are no validated process-based performance measures that could quantify optimal care

BMS=bare metal stents; CABG=coronary artery bypass grafting; CTA=computerized tomography-based angiography; DES=drug eluting stents; MI=myocardial infarction; MRA=magnetic resonance angiography; PCI=percutaneous coronary intervention; QoL=quality of life; SPECT=single photon emission computerized tomography

From: Appendix B, Search Prioritization Tools

Cover of Future Research Needs for the Comparison of Percutaneous Coronary Interventions with Bypass Graft Surgery in Nonacute Coronary Artery Disease
Future Research Needs for the Comparison of Percutaneous Coronary Interventions with Bypass Graft Surgery in Nonacute Coronary Artery Disease: Identification of Future Research Needs from Comparative Effectiveness Review No. 9 [Internet].
Future Research Needs Papers, No. 1.
Trikalinos TA, Dahabreh IJ, Wong J, et al.
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