Purpose The purpose of this study was to determine the outcomes of a consecutive series of patients treated with coronary angioplasty in a Veterans Affairs hospital to determine if the increased cost of drug eluting stents was justified by improved clinical status.
Methods Eighty-three consecutive patients undergoing coronary angioplasty were followed for 12 months including 38 procedures immediately prior to the introduction of drug eluting stents using bare metal stents (Group 1-BMS) and 45 consecutive patients treated with drug eluting stents (Group2-DES). The composite clinical end point (MACE) of death, myocardial infarction symptomatic resenosis, and target vessel failure was tabulated.
Results (1) Adverse coronary events occurred in 6/38 (15.8%) in Group1-BMS and 6/45(13.3%) in Group 2-DES (p = NS). (2) No differences were found in the number of additional hospital days for treatment of cardiac disease: 2.92 (SD 8.42) hospital days in Group 1-BMS and 2.91 (SD 6.59) hospital days in Group 2-DES. Cox survival regression analysis identified more complex coronary lesions as the major predictor (p = 0.023) of MACE. The type of stent used was not significant.
Conclusions (1) Drug eluting stents increase the cost of each procedure but may not improve the clinical outcomes in a patient population with multiple risk factors and complex coronary anatomy. (2) Lesion morphology remains an important consideration in evaluating the risks and benefits of coronary interventions. (3) Additional studies may allow measures of outcome to achieve statistical significance, but reduced combined MACE following the use of DES has not been confirmed in the Veterans Affairs health care system. Tabulation of results in high risk interventions or clinical groups such as diabetic patients may provide additional information.