Author + information
- Robert J. Applegate,
- Matthew Sacrinty,
- Sanjay Gandhi,
- Michael Kutcher,
- Renato Santos and
- William Little
Analyses of relative effectiveness of 1st generation drug-eluting stents vs bare metal stents (BMS) concluded that drug-eluting stents should be used only for stented diameters <3.0 mm and lengths ≥15 mm, and at a cost differential of <$500. Whether similar recommendations would be supported with newer generation everolimus-eluting stents (EES) is unknown.
Single-lesion percutaneous coronary interventions with BMS (n=600) and EES (n=741) were performed at a single center (Wake Forest Baptist Medical Center) between January 2007 and December 2010. One year clinical outcomes and costs were compared between propensity score matched cohorts (n=555 for each), with complete 1-year follow-up >94% for each. All costs were in 2012 US dollars, including generic clopidogrel ($1/day).
Matched baseline characteristics were similar for EES vs BMS (all standardized differences <10%). Clopidogrel use at 1-year was 87% EES vs 61% BMS (p<0.001). EES reduced target lesion revascularization (TLR) vs BMS (−5.0%, p<0.001) and 1-year aggregate costs were $241 more for EES ($769 less to $1,281 more) vs BMS. Aggregate 1-year costs and cost effectiveness ratios stratified by stented length and diameter are shown in the figure.
EES reduced TLR and was cost effective vs BMS across stented length and diameter stratifications. These observations suggest that selective stent strategies based on diameter and length may result in suboptimal utilization.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Enhancing Value in Coronary Intervention and Myocardial Infarction Care
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1157M-96
- 2013 American College of Cardiology Foundation