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A retrospective study of 6,671 patients comparing coronary stenting and balloon angioplasty
R Heuser1, F Houser, S D Culler
1Phoenix Heart Center, Phoenix, Arizona, USA. phoenixheart@eartlink.net
Insights
Coronary stenting did not significantly reduce major adverse clinical outcomes compared to balloon angioplasty over six months. While stenting reduced emergency bypass surgery, its cost-effectiveness for hard clinical outcomes requires further establishment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Economics
Background:
- Debate exists on coronary stent clinical benefits amidst rising use and costs.
- Evaluating stent effectiveness is crucial for patient care and healthcare resource allocation.
Purpose of the Study:
- To compare coronary stenting versus percutaneous transluminal coronary angioplasty (PTCA) for five clinical endpoints.
- To assess the six-month clinical outcomes and cost-effectiveness of coronary stenting.
Main Methods:
- A total of 6,671 patients undergoing revascularization were analyzed.
- Patients were randomized to either standard balloon angioplasty (PTCA) or coronary stenting (STENT).
- Outcomes were evaluated over a six-month follow-up period.
Main Results:
- Coronary stenting significantly reduced emergency coronary artery bypass surgery and in-hospital mortality.
- STENT patients had higher rates of hematoma and bradycardia.
- After risk adjustment, stenting significantly reduced myocardial infarction but not other major adverse events.
Conclusions:
- Coronary stenting showed no statistically significant advantage over PTCA for major clinical outcomes at six months.
- The significantly higher cost of coronary stenting necessitates further evaluation of its cost-effectiveness.
- Establishing cost-effectiveness for hard clinical outcomes remains a key consideration.
Objective:
To determine whether coronary stenting, compared to percutaneous transluminal coronary angioplasty, reduces the incidence of five clinical endpoints during a six-month follow-up period.
Background:
There is considerable debate concerning whether coronary stents improve clinical outcomes, especially given the rapid growth in the use of coronary stents and their economic impact.
Methods:
Study population included a total of 6,671 consecutive patients at 32 hospitals in 16 different states who underwent single or multi-vessel revascularization during 1997. Patients were divided into one of two groups: those who only underwent standard balloon angioplasty (PTCA) for all treated vessels and those who received coronary stents (STENT) in all treated vessels.
Results:
STENT patients were significantly less likely to have emergency coronary artery bypass surgery (CABG) (p = 0.001) or die during initial procedure (p = 0.034) but were more likely than PTCA patients to be treated for hematoma (p = 0.002) and bradycardia (p = 0.004). After accounting for difference in patient characteristics, risk factors, procedure complications, and number of devices utilized, the estimated odds-ratio indicates that coronary stenting, compared to PTCA, significantly (p < 0.05) reduced adverse outcomes for only one clinical event, myocardial infarction.
Conclusions:
Compared to balloon angioplasty patients, coronary stent patients have no statistically significant differences in regard to additional percutaneous coronary intervention or coronary artery bypass during a six-month follow-up period. Since direct cardiac catheterization lab costs associated with coronary stenting is nearly 2.5 times greater than standard balloon angioplasty, our results suggest the cost-effectiveness of coronary stenting, especially for "hard" clinical outcomes, needs to be established.