Changes in Drug Eluting Stent Usage During a Four-Year Time Period in a Regional Cath Lab in New South Wales

Abstract

The safety and cost effectiveness of Drug eluting stents (DES) were not well established compared to Bare metal stents (BMS) in the past1. Earlier guidelines had recommended a selective use of DES2,3. However, subsequent studies have shown that DES, particularly the newer generation stents have better safety profile than BMS4. The aim of this analysis was to study the changes in DES usage in a regional Cath Lab at Lismore Base Hospital in NSW during a four year time period from 2012 to 2015. A total of 515 cases of coronary angioplasty with stenting were done during this period (average age 67+/-12 years; 67% males). 666 stents were used. Average number of stents used per case was 1.3. In 2012 out of the 146 stents used for 112 cases, 90 were DES (62%) and 56 were BMS (38%). The number of DES used was 116(70%) and BMS was 50(30%) out of a total 166 stents used for 125 cases in 2013. In 2014 the number of DES used was 123(64%) and BMS was 68(36%) out of total 191 stents for 146 cases. In 2015 the DES usage was 146(90%) and BMS usage was 17(10%) out of 163 stents used in 132 cases. The current study showed a clear increase in DES usage from an average 65% between 2012 and 2014 to 90% in 2015. This reflects the current recommendations for use of new generation DES, which have improved safety profile, clinical efficacy and cost effectiveness compared to BMS4,5.1.Lagerqvist B, James SK, Stenestrand U, Lindback J, et al. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 2007;356(10):1009-1019.2.King SB 3rd, Smith SC Jr, Hirshfeld JW Jr et al., 2007 focussed update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol. 2008 Jan 15;51(2):172-209.3.Clinical Guidelines for the Use of Drug Eluting Coronary Artery Stents in Public Hospitals in NSW. Greater Metropolitan Clinical Taskforce Cardiac Coordinating Committee, May 2008.4.Windecker S, Kolh P, Alfonso F et al., 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2014 Oct 1;35(37):2541-2619..5.Revision of clinical guidelines for the use of Drug eluting coronary artery stents in public hospitals in NSW. Agency for clinical innovation draft publication 2015.