Impact of Drug-Eluting Stents on Treatment Option Mix for Coronary Artery Disease in Japan

Abstract

In Japan, drug-eluting stents (DES) were introduced in September 2004. The aim of the present study was to clarify how DES affected the proportions of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) procedures performed in Japan. Using the Japanese Diagnosis Procedure Combination (DPC) inpatient database, 19,248 patients with angina pectoris (AP) and 2,895 patients with acute myocardial infarction (AMI) were identified from 144 hospitals in July of each year between 2004 and 2007. Among AP patients, the proportion of conservative therapies decreased from 70% in 2004 to 61% in 2007, while the proportion of PCI procedures increased from 25% in 2004 to 32% in 2007. On-pump CABG cases decreased from 3.5% in 2004 to 2.7% in 2007, but the number of off-pump CABG cases continuously increased from 2.2% in 2004 to 4.0% in 2007. Overall in-hospital mortality in AP patients gradually decreased from 0.35% in 2004 to 0.18% in 2007. In 2007, DES was used in 23% of all AP patients and 26% of all AMI patients. Multi-nominal logistic regression analysis showed that the proportional use of DES was greater in non-teaching hospitals than in teaching hospitals. There has been marked expansion of PCI and a gradual increase in off-pump CABG after the introduction of DES. It is essential to establish guidelines in Japan for a consensus between cardiologists and cardiovascular surgeons on evidence-based best practice.