Coronary stenting in routine interventional practice

Coronary stents have revolutionised interventional cardiology, providing a 'bail-out' option when angioplasty results are unsatisfactory, and reducing the risk of restenosis. However, despite the results of randomised trials, concerns have been expressed about whether stent insertion is cost-effective in routine clinical practice.

The notes of 356 patients who underwent stent insertion in Oxford between January 1996 and March 1997 were examined. Long-term follow-up information was obtained from questionnaires sent to general practitioners and patients.

The procedure was successful in 327 (92%) cases. Eighteen (5.1%) patients suffered a serious coronary complication, and 13 (3.7%) a bleeding complication. Over the year following stent insertion, 238 (83%) of the 286 patients followed-up had suffered no coronary event, and 88% were in Canadian Cardiovascular Society (CCS) angina class II or below (slight limitation of normal daily activity at worst).

Whilst the initial cost of stent insertion is considerably greater than that of angioplasty alone, it reduces the need for high risk emergency bypass surgery or redo percutaneous intervention. Stent insertion thus represents a clear advantage for patients who have unsatisfactory angioplasties and may be a more cost-effective option.