Abstract 177: Impact of a Drug-eluting Stent Guideline on Clinical Practice

Abstract

Introduction: In Victorian public hospitals drug-eluting stents (DES) are reserved for patients at high-risk of in-stent restenosis. A hospital guideline was developed in consultation with cardiologists following systematic review of the literature to improve the consistency of percutaneous coronary intervention (PCI) practice and the clinical decision-making behind stent implantation. Indications for DES deployment were Diabetes Mellitus; Lesion Length >20mm or Diameter <2.5mm; Chronic Total Occlusion; In-stent Restenosis; Saphenous Vein Graft; Left Main; Proximal Left Anterior Descending Artery; Bifurcation or Ostial Lesion; Chronic Renal Failure. Method: Retrospective study involving a 4-week audit conducted pre-guideline implementation in April 2009 and two subsequent audits post-guideline implementation in September 2011 and April 2012. The guideline was introduced in February 2011. Results: The number of patients in each cohort was 38 (2009), 45 (2011) and 47 (2012). Overall there was an increase in DES usage from 39.5% (2009) to 62.2% (2011) and 59.6% (2012). However, the percentage of patients meeting one or more indication for DES use without a documented contraindication also increased from 31.6% (2009) to 62.2% (2011) and 59.6% (2012). Following guideline implementation the percentage of patients that received a DES without indication decreased from 7.9% to 0% (both 2011 and 2012), and those indicated for DES who subsequently received a bare-metal stent (BMS) also decreased from 18.4% to 2.2% (2011) and 2.1% (2012). Conclusion: Introduction of the guideline did not reduce the rate of DES deployment. However, it significantly improved clinical practice and appropriateness of DES and BMS usage. This improvement was again measurable and sustained 12 months following guideline implementation.