August 15th, 2011
Bare Metal Stents: The Next New Thing?
Larry Husten, PHD
Although drug-eluting stents (DES) have largely supplanted bare metal stents (BMS) in clinical practice, a new study published in Circulation suggests that using these devices in all patients may represent an inefficient use of healthcare resources. Lakshmi Venkitachalam and colleagues analyzed data from 10,144 PCI patients enrolled in the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry.
Largely in response to concerns about the possible risks associated with DES, the use of DES decreased from 92% to 68% from 2004 to 2007, according to the registry. However, the rates of death and MI did not change over time, although the rate of target lesion revascularization (TLR) increased absolutely by 1% (from 4.1% to 5.1%). Total cardiovascular cost per patient decreased by $401. The authors estimate that the risk-adjusted incremental cost-effectiveness ratio for the more liberal compared with selective use of DES was $16,000 per TLR avoided, $27,000 per repeat revascularization avoided, and $433,000 per quality-adjusted life-year gained.
The authors write that their findings “suggest that in an era of constrained resources, a more selective approach to DES use would be preferred, at least on economic grounds. With nearly 1 million PCI procedures annually in the United States, adoption of the more selective DES strategy would be expected to result in ~$400 million/y in annual cost savings to the US healthcare system.”
“The bottom-line was that using drug-eluting stents in a relatively unselected way was only resulting in marginal improvement compared to more selective use,” said David Cohen, the senior author of the study, in an AHA press release. “Because of the safety concerns, we were able to verify what many of us had suspected — that using drug-eluting stents in virtually all patients is not that efficient.”
Categories: Uncategorized
Tags: bare metal stents, BMS, DES, drug-eluting stents, Interventional Cardiology
You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.
Comments are closed.
-
NEJM Journal Watch — Recent Cardiology Articles
-
Sign up for NEJM Journal Watch Cardiology Alerts
Receive a free weekly email with the latest summaries on Cardiology.
-
Tag Cloud
- ACS AF AHA anticoagulation aortic valve replacement apixaban aspirin atrial fibrillation CABG cardiovascular risk cholesterol clopidogrel dabigatran diabetes diet drug-eluting stents epidemiology ESC exercise FDA FDA approvals Fellowship training guidelines HDL heart failure hypertension ICDs MI myocardial infarction obesity PCI Primary PCI risk factors rivaroxaban statins STEMI stents stroke stroke prevention TAVI TAVR type 2 diabetes venous thromboembolism warfarin women