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Treatment variation in stent choice in patients with stable or unstable coronary artery disease

L T Burgers1, E A McClellan2, I E Hoefer3

  • 1Institute of Health Policy & Management, and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands. ltburgers@gmail.com.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|January 15, 2016
PubMed

Insights

Hospital factors significantly influence stent choice in coronary artery disease (CAD) patients, impacting long-term outcomes. This suggests treatment variation beyond patient clinical factors.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Health Services Research

Background:

  • Treatment variations in coronary artery disease (CAD) can stem from demographic, clinical, physician, and hospital factors.
  • Stent choice, specifically drug-eluting stents (DES) versus bare-metal stents (BMS), is critical due to potential long-term outcome differences.

Purpose of the Study:

  • To investigate factors associated with stent selection (DES vs. BMS) in Dutch patients with stable or unstable CAD.
  • To determine the influence of patient characteristics and hospital-level factors on stent choice.

Main Methods:

  • Prospective cohort study of 692 patients with stable or unstable CAD.
  • Analysis of 442 patients treated with BMS or DES using multiple logistic regression.
  • Identification of variables associated with stent type through bivariate and multivariate analyses.

Main Results:

  • Patient factors such as NYHA class, number of diseased vessels, prior percutaneous coronary intervention, smoking, and diabetes were associated with stent type.
  • The treating hospital was significantly associated with stent choice in the overall cohort and remained significant for the stable CAD population after adjustments.

Conclusions:

  • Stent choice in CAD patients is influenced by a combination of clinical factors and the treating hospital.
  • While patient clinical characteristics generally guide optimal stent selection, hospital-level variations persist, potentially affecting long-term patient outcomes.
Abstract

Keywords:
Bare-metal stentCoronary artery diseaseDrug-eluting stentPercutaneous coronary interventionTreatment variation

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