Article Text

  1. S. R. Senter,
  2. S. Nathan,
  3. P. Bhatt,
  4. A. Gupta,
  5. J. Calvin,
  6. L. W. Klein
  1. Chicago, IL
  2. Center for Genetic Medicine Research


Background Although evidence-based recommendations for drug-eluting stents (DES) are well known, an understanding of actual utilization in contemporary practice is limited.

Methods Between April 2003 and May 2004, a total of 219 consecutive cases of DES to treat 252 lesions in 205 patients were compared to 3 evidence-based categories (refer to graphic). Procedure costs were determined by ratio of cost-to-charges and the incremental cost for DES equal to $2000.

Results Patients were predominantly male (72%), with a mean age of 63 ± 11 years; 38% were diabetic, 18% had MI within the last 30 days, and 22% had prior CABG. Most cases were elective (94%), but 34% (94/277) of DES were deployed in less favorable lesions: 10% bifurcation, 7% chronic total occlusion (CTO), 7% saphenous vein graft (SVG), 6% in-stent restenosis (ISR), and 3% ostial. Per case, 1.3 ± 0.5 DES were used: 76% (161/219) had 1 DES, 20% (43/219) had 2 DES, and 4% (8/219) had 3 DES. Over 1 year, each patient received 1.4 ± 0.5 DES with a mean length of stay of 2.0 days. In contemporary practice, 62% of DES were used outside of Level A recommendations at an incremental cost of $1714.

Conclusions The use of DES in contemporary practice differs significantly from current evidence-based recommendations, resulting in significantly increased utilization and cost. Further investigation is needed substantiate the benefit of DES, decreased restenosis, in these subgroups. (Figure)

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