Two studies presented at ESC Congress 2026, and published in JACC offer new insights into the costs and long-term outcomes of cardiovascular therapies, with one analysis examining hospital costs associated with microaxial flow pump (mAFP) therapy and another assessing 20-year all-cause mortality after PCI vs. CABG.

Costs Associated With mAFP Therapy
In an analysis of the DanGer Shock study, conducted at 14 tertiary cardiac centers in Denmark, Germany and the U.K., researchers developed trial-based estimates of hospital costs through 180 days associated with routine mAFP therapy compared with standard care from the time of randomization. The main results of DanGer Shock, presented at ACC.24, showed that mAFP therapy reduced all-cause mortality in selected patients with STEMI complicated by cardiogenic shock.

Researchers performed a prespecified within-trial analysis to generate cost estimates for each of the two treatments among 355 patients: 179 in the mAFP therapy plus standard care group and 176 in the standard care-only group. The median age was 69 years and 79% of patients were men. At 180 days, fewer patients in the mAFP group than in the standard-care group had died (82 vs. 103; hazard ratio, 0.74).

The median duration of the ICU stay was six days for the mAFP group vs. three days for the standard-care group. The median general ward stay was three days.

The higher survival rate in the mAFP group was associated with a higher cost per patient of US$42,000 through 180 days than for patients in the standard-care group. In the two groups, respectively, the mean index hospitalization costs per patient were US$95,871 ± $108,814 and US$51,984 ± $85,333, and total hospital costs were US$98,199 ± $109,580 and US$55,808 ± $93,272.

“The additional costs were concentrated during the index hospitalization, with little evidence of an offset in hospital costs accumulated after the index hospitalization through 180 days,” write Britt Borregaard, MPQM, PhD, et al. They note that the costs were low and similar in both groups after 180 days.

20-Year All-Cause Mortality After PCI vs. CABG
In the second study, an exploratory extension of a randomized trial comparing PCI and CABG, found no significant difference in all-cause mortality over the median follow-up of 15.2 years among patients with de novo left main coronary artery stenosis of ≥50% who were symptomatic or had documented myocardial ischemia (hazard ratio, 0.97; 95% CI, 0.65-1.39; p=0.795).

In the main study, 100 patients were randomly assigned to the PCI cohort and 101 to the CABG cohort. The study found that PCI with sirolimus-eluting stents was inferior to CABG for major adverse cardiac events (19.0% vs. 13.9%) at 12 months.

In the extended follow-up looking at vital status with an endpoint of all-cause mortality, researchers estimated restricted mean survival time differences through 10 and 15 years.

At five years, estimated survival in the PCI and CABG groups was 87.9% and 86.1%. At 10 years, it was 69.7% and 76.1%. At 15 years, it was 52.3% and 53.9%, and at 20 years, it was 43.1% and 41.0%.

The difference in the estimated restricted mean survival time for PCI compared with CABG was 0.11 years through 10 years (95% CI, –0.65-0.86 years; p=0.78) and 0.09 years through 15 years (95% CI, –1.19-1.36 years; p=0.893).

“In this exploratory randomized-trial extension, no statistically significant difference in all-cause mortality was detected between assignment to PCI and assignment to CABG,” write Steffen Desch, MD, et al. “However, the broad confidence interval does not exclude a clinically meaningful advantage of either strategy.” They note that the hazard ratio is an average effect and may not capture temporal variation. “The principal contribution is randomized vital status follow-up beyond 10 years, not evidence of equivalence,” they add.

Visit the JACC Journals at ESC Congress 2026 page to see the full list of simultaneous publications.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: ESC Congress, ESC26, Costs and Cost Analysis, Mortality, Percutaneous Coronary Intervention, Coronary Artery Bypass