Use of drug-eluting stents varies widely; Modestly correlated with coronary artery restenosis risk

July 9, 2012

A study based on more than 1.5 million percutaneous coronary intervention procedures (such as balloon angioplasty or stent placement to open narrowed coronary arteries) suggests that the use of drug-eluting stents varies widely among U.S. physicians, and is only modestly correlated with the patient's risk of coronary artery restenosis (renarrowing), according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.

Drug-eluting stents (DES) are effective in reducing restenosis and the benefits are greatest in patients at the highest risk of target-vessel revascularization (TVR). Drug-eluting stents cost more than bare-metal stents (BMS), and they require prolonged dual (DAPT), which increases costs, bleeding and complication risk if DAPT is ended too early, according to the study background.

Amit P. Amin, M.D., M.Sc., of Barnes Jewish Hospital, Washington University School of Medicine, St. Louis, Mo., and colleagues analyzed more than 1.5 million PCI procedures in the National Cardiovascular Data Registry (NCDR) CathPCI registry from 2004 through much of 2010. They sought to examine variation in DES use among physicians, whether predicted TVR risk with bare-metal stents was associated with DES use, and what the estimated clinical and were of lower DES use among patients with low TVR risk.

"The present study demonstrates that in current U.S. practice, DES use is prevalent, even among patients at low risk of developing restenosis. There was also significant variation in the rate of DES use by individual physicians. A reduction in DES use among patients at low risk for was projected to be associated with substantial costs savings with only a small increase in TVR events," the authors note.

According to study results, drug-eluting stent use was 73.9 percent among those at a low risk for TVR, 78 percent among those at moderate risk and 83.2 percent among those at the highest TVR risk.

The study suggests that a 50 percent reduction in the use of DES in low-TVR-risk patients was projected to lower costs by about $205 million per year in the U.S., while increasing the overall TVR event rate by 0.5 percent.

"Given the marked variation in physicians' DES use, a strategy of lower DES use among patients at low risk of TVR could present an important opportunity to reduce health care expenditures while preserving the vast majority of their clinical benefit," the authors conclude.

In an invited commentary, Peter W. Groeneveld, M.D., M.S., of the University of Pennsylvania, Philadelphia, writes: "New medical technologies are the primary drivers of rising health care costs, but the U.S. health care system has generally performed poorly in incorporating new drugs, devices, imaging techniques and invasive procedures in a manner that maximizes the value – defined as health benefits relative to costs – delivered to while simultaneously restraining the use of such technologies in settings where they predictably provide little or no value."

"The use pattern of DES during the past nine years illustrates how far away the system is from consistently embracing value-based medical decision making, and it also enumerates the many barriers and inertial practices in U.S. health care that must be surmounted to reach economic sustainability," Groeneveld concludes.

Explore further: Considerably lower risk of stent thrombosis and restenosis in 'new generation' drug-eluting stents

More information: Arch Intern Med. Published online July 9, 2012. doi:10.1001/archinternmed.2012.3093
Arch Intern Med. Published online July 9, 2012. doi:10.1001/archinternmed.2012.2724

Related Stories

Considerably lower risk of stent thrombosis and restenosis in 'new generation' drug-eluting stents

August 30, 2011
Results from the SCAAR study, presented at the ESC Congress 2011 today, showed that Percutaneous Coronary Intervention (PCI) with "new generation" Drug Eluting Stents, was associated with a 38% lower risk of clinically meaningful ...

New 'real-world' reassuring data from the SCAAR registry

January 9, 2012
A registry -which includes every patient in Sweden having percutaneous coronary intervention (PCI) for the treatment of acute and stable coronary artery disease- has found that PCI implantations using a new generation of ...

An 'important' reduction in risk of stent thrombosis with everolimus-eluting stent

August 30, 2011
Results of the independently-funded Bern-Rotterdam cohort study provide robust evidence of an "important" reduction in overall and very late stent thrombosis. The reduction in incidence was found when a newer generation everolimus-eluting ...

Recommended for you

Low-salt and heart-healthy dash diet as effective as drugs for some adults with high blood pressure

November 22, 2017
A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure—the top number in ...

Stroke patients may have more time to get treatment, study finds

November 22, 2017
Patients and doctors long have relied on a simple rule of thumb for seeking care after an ischemic stroke: "Time is brain."

Cases of heart failure continue to rise; poorest people worst affected

November 22, 2017
The number of people being diagnosed with heart failure in the UK continues to rise as a result of demographic changes common to many developed countries, new research by The George Institute for Global Health at the University ...

Some cancer therapies may provide a new way to treat high blood pressure

November 20, 2017
Drugs designed to halt cancer growth may offer a new way to control high blood pressure (hypertension), say Georgetown University Medical Center investigators. The finding could offer a real advance in hypertension treatment ...

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.