Abstract P118: Changes in Patient Predictors of Use of Drug-Eluting Coronary Stents After FDA Warnings in Early 2007

Abstract

Objective: Use of drug-eluting stents (DES) in PCI began to decline in late 2006 after release of scientific findings of higher risk of late stent thrombosis with DES. An emergency meeting of the FDA advisory panel cautioned about complications resulting from off-label use of DES. In this study, we compared early 2006 (pre-controversy) with late 2007 (post-controversy) patient predictors of use of DES vs. BMS for STEMI, NSTEMI, and stable CHD. Methods: We compared pre-controversy vs. post-controversy predictors of DES vs. BMS for STEMI (n= 9,341), NSTEMI (n=21,410) and stable CHD (n=23,495) through multivariate logistic regression analysis of hospital discharge data for Florida. Results: Throughout the study period, we observed reduced rates of DES implantation in patients with CHF (NSTEMI), cardiomyopathy (STEMI), Medicaid (STEMI and CHD), smoking (NSTEMI and CHD), medication noncompliance (STEMI, NSTEMI and CHD), and drug abuse (STEMI). Compared to the pre-controversy era, new deterrents to DES use post-controversy for STEMI patients were age >75 years, atrial fibrillation (AF), anticoagulation medication (AM), and smoking; while for NSTEMI new deterrents to DES were age >85 years, AF, AM, alcohol abuse and drug abuse. For stable CHD, in the pre-controversy era, patients aged 45-54 years were more likely to get DES, while those with diabetes mellitus were less likely to get DES. In the post-controversy era, new deterrents to DES use were age > 75 years, CHF, AF, peripheral vascular disease, AM, chronic kidney disease, alcohol abuse, or a history of medication noncompliance. Blacks with NSTEMI were more likely to get DES (OR 1.4; 95% CI 1.03-2.01; p=0.03) in the pre-controversy era, but less likely (OR 0.7; 95% CI 0.59-0.83; p<0.0001) in the post-controversy era. In contrast, the likelihood of DES implantation for blacks was significantly lower (OR 0.61; 95% CI 0.43-0.87; p=0.006) for STEMI in the pre-controversy era only and not different for stable CHD. Conclusions: In the state of Florida, the reduction in DES use post-controversy is related to older age, presence of co-morbidities like atrial fibrillation requiring additional anticoagulants and patient markers of potential non-compliance with thienopyridines (e.g. alcohol and drug abuse).