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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Effects of coronary stents on cardiovascular outcomes in broad-based clinical practice
S E Kimmel1, A R Localio, C Brensinger
1University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 717 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021,USA. skimmel@cceb.med.upenn.edu
Insights
Coronary stents reduce the need for repeat procedures in real-world practice, confirming trial results. However, this study found no impact on subsequent heart attack or cardiac death rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Randomized trials show coronary stents reduce repeat percutaneous coronary intervention (PCI).
- Real-world effectiveness of stents in diverse clinical practice remains understudied.
- Impact of stents on myocardial infarction and cardiac death requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of coronary stents in reducing repeat PCI procedures in a broad clinical setting.
- To assess the impact of stents on in-hospital events, revascularization rates, and subsequent myocardial infarction or cardiac death.
- To compare stent outcomes with non-stent procedures in a large patient cohort.
Main Methods:
- Retrospective cohort study using the Pennsylvania Health Care Cost Containment Council database.
- Included 5258 patients undergoing PCI across 43 hospitals in late 1995.
- Primary outcomes: in-hospital events (death/coronary bypass), 6-month revascularization, and 6-month cardiac death/myocardial infarction.
Main Results:
- Stent use (24% of patients) significantly reduced in-hospital events, primarily coronary bypass surgery (52% reduction).
- Stents decreased the need for follow-up revascularization, including a 31% reduction in repeated PCI.
- No significant effect of stents was observed on 6-month rates of myocardial infarction or cardiac death.
Conclusions:
- Coronary stents effectively decrease repeat PCI in broad clinical practice, aligning with randomized trial findings.
- This study did not find evidence that stents reduce subsequent myocardial infarction or cardiac death.
- Real-world data confirms stent benefits for procedural outcomes but highlights the need for continued research on long-term clinical endpoints.
Background:
Although stents have been shown to reduce the need for repeated percutaneous coronary intervention (PCI) in randomized trials, the effects of stents in broad-based, diverse clinical practice have not been well studied, nor has their effect on subsequent myocardial infarction or cardiac death.
Methods:
A retrospective cohort study was performed that included all 43 hospitals performing PCI in Pennsylvania in the last quarter of 1995, with the use of the Pennsylvania Health Care Cost Containment Council database. All 5258 patients who underwent PCI, excluding those with previous PCI within the preceding 6 months, were included. The primary outcomes were in-hospital events (death or coronary bypass), 6-month revascularization rates, and 6-month rates of cardiac death or myocardial infarction.
Results:
A total of 1240 patients (24%) had a stent procedure. Compared with nonstent procedures, stents reduced the risk of in-hospital events (multivariable odds ratio adjusted for patient and hospital level differences, 0.63; 95% confidence interval, 0.41-0.97), primarily because of a 52% reduction in the need for coronary bypass. Stents also reduced the need for follow-up revascularization procedures (multivariable hazard ratio, 0.72; 95% confidence interval, 0.59-0. 87), primarily because of a 31% reduction in repeated PCI. However, stents had no effect on 6-month rate of myocardial infarction or cardiac death (multivariable hazard ratio, 0.97; 95% confidence interval, 0.71-1.33).
Conclusions:
Using stents decreases the need for repeated PCI in broad-based clinical practice, confirming results from randomized trials. However, this study did not detect any effect on subsequent myocardial infarction or cardiac death.
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