Use of drug eluting stents increases in the US but only for some groups
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《英国医生杂志》
In the nine months after the first drug eluting stent was approved in the United States, the new style stent was used in 35% of all angioplasties. Stents—metal scaffold tubes that support arteries after balloon angioplasty—can be coated in a slow release drug to reduce restenosis, in which the artery becomes blocked again.
The sirolimus-eluting Cypher stent, the first to be approved in the US, was used in 35% of angioplasties in the nine months after its approval
Credit: CORDIS CORPORATION
Use of drug eluting stents rose rapidly, from 20% in the first quarter after its introduction to 45% in the third quarter. Plain metal stents, however, were more likely to be used in patients without health insurance, Native Americans, African-Americans, and patients who had had a coronary artery bypass graft.
Sunil Rao, assistant professor of medicine at Duke University Medical Center in Durham, North Carolina, reported that both drug eluting and plain metal stents were used in 83% of the 162 969 percutaneous coronary interventions done at 259 US sites from April 2003 (when the Cypher stent became available) to December 2003.
In an abstract presented at the meeting of the American Heart Association in New Orleans, Dr Rao and colleagues used multivariable logistic regression, including hospital, patient, and lesion characteristics, to determine predictors of drug eluting stents compared with plain metal stents.
The data were collected in a large multicentre national quality improvement initiative for cardiac catheterisation laboratories run by the American College of Cardiology's national cardiovascular disease registry. The college uses the data to generate a quality report that tells each centre how it compares with practices in the rest of the country, Dr Rao told the BMJ.
Dr Rao's study also found that low volume hospitals and government hospitals (mostly veterans' hospitals) were more likely to use plain metal stents. Bare metal stents were also likely to be used on patients who had received a stent as an emergency procedure, were in shock at presentation, or who had had an acute myocardial infarction in the 24 hours before a stent was fitted.
Elderly patients were more likely to have diffuse disease and to have arteries that were too small to use a stent and might receive bypass surgery, he said.
The drug eluting stent was almost twice as expensive as the plain metal one, although costs have come down, he said. Patients receiving a plain stent were usually prescribed aspirin and an expensive antiplatelet drug for one month afterwards; those receiving a drug eluting stent required the expensive drug for three to six months.
In a second study, Dr Rao found that the stents were used almost equally in approved clinical situations and in those not included in the initial indication—unapproved or "off-label" use. Unapproved uses included patients with a myocardial infarction, with complex lesions, and who had had restenosis with a previous stent.
Use of drug eluting stents increases in the US but only for some groups
Janice Hopkins Tanne
New York
In the nine months after the first drug eluting stent was approved in the United States, the new style stent was used in 35% of all angioplasties. Stents—metal scaffold tubes that support arteries after balloon angioplasty—can be coated in a slow release drug to reduce restenosis, in which the artery becomes blocked again.
The sirolimus-eluting Cypher stent, the first to be approved in the US, was used in 35% of angioplasties in the nine months after its approval
Credit: CORDIS CORPORATION
Use of drug eluting stents rose rapidly, from 20% in the first quarter after its introduction to 45% in the third quarter. Plain metal stents, however, were more likely to be used in patients without health insurance, Native Americans, African-Americans, and patients who had had a coronary artery bypass graft.
Sunil Rao, assistant professor of medicine at Duke University Medical Center in Durham, North Carolina, reported that both drug eluting and plain metal stents were used in 83% of the 162 969 percutaneous coronary interventions done at 259 US sites from April 2003 (when the Cypher stent became available) to December 2003.
In an abstract presented at the meeting of the American Heart Association in New Orleans, Dr Rao and colleagues used multivariable logistic regression, including hospital, patient, and lesion characteristics, to determine predictors of drug eluting stents compared with plain metal stents.
The data were collected in a large multicentre national quality improvement initiative for cardiac catheterisation laboratories run by the American College of Cardiology's national cardiovascular disease registry. The college uses the data to generate a quality report that tells each centre how it compares with practices in the rest of the country, Dr Rao told the BMJ.
Dr Rao's study also found that low volume hospitals and government hospitals (mostly veterans' hospitals) were more likely to use plain metal stents. Bare metal stents were also likely to be used on patients who had received a stent as an emergency procedure, were in shock at presentation, or who had had an acute myocardial infarction in the 24 hours before a stent was fitted.
Elderly patients were more likely to have diffuse disease and to have arteries that were too small to use a stent and might receive bypass surgery, he said.
The drug eluting stent was almost twice as expensive as the plain metal one, although costs have come down, he said. Patients receiving a plain stent were usually prescribed aspirin and an expensive antiplatelet drug for one month afterwards; those receiving a drug eluting stent required the expensive drug for three to six months.
In a second study, Dr Rao found that the stents were used almost equally in approved clinical situations and in those not included in the initial indication—unapproved or "off-label" use. Unapproved uses included patients with a myocardial infarction, with complex lesions, and who had had restenosis with a previous stent.(Janice Hopkins Tanne)
The sirolimus-eluting Cypher stent, the first to be approved in the US, was used in 35% of angioplasties in the nine months after its approval
Credit: CORDIS CORPORATION
Use of drug eluting stents rose rapidly, from 20% in the first quarter after its introduction to 45% in the third quarter. Plain metal stents, however, were more likely to be used in patients without health insurance, Native Americans, African-Americans, and patients who had had a coronary artery bypass graft.
Sunil Rao, assistant professor of medicine at Duke University Medical Center in Durham, North Carolina, reported that both drug eluting and plain metal stents were used in 83% of the 162 969 percutaneous coronary interventions done at 259 US sites from April 2003 (when the Cypher stent became available) to December 2003.
In an abstract presented at the meeting of the American Heart Association in New Orleans, Dr Rao and colleagues used multivariable logistic regression, including hospital, patient, and lesion characteristics, to determine predictors of drug eluting stents compared with plain metal stents.
The data were collected in a large multicentre national quality improvement initiative for cardiac catheterisation laboratories run by the American College of Cardiology's national cardiovascular disease registry. The college uses the data to generate a quality report that tells each centre how it compares with practices in the rest of the country, Dr Rao told the BMJ.
Dr Rao's study also found that low volume hospitals and government hospitals (mostly veterans' hospitals) were more likely to use plain metal stents. Bare metal stents were also likely to be used on patients who had received a stent as an emergency procedure, were in shock at presentation, or who had had an acute myocardial infarction in the 24 hours before a stent was fitted.
Elderly patients were more likely to have diffuse disease and to have arteries that were too small to use a stent and might receive bypass surgery, he said.
The drug eluting stent was almost twice as expensive as the plain metal one, although costs have come down, he said. Patients receiving a plain stent were usually prescribed aspirin and an expensive antiplatelet drug for one month afterwards; those receiving a drug eluting stent required the expensive drug for three to six months.
In a second study, Dr Rao found that the stents were used almost equally in approved clinical situations and in those not included in the initial indication—unapproved or "off-label" use. Unapproved uses included patients with a myocardial infarction, with complex lesions, and who had had restenosis with a previous stent.
Use of drug eluting stents increases in the US but only for some groups
Janice Hopkins Tanne
New York
In the nine months after the first drug eluting stent was approved in the United States, the new style stent was used in 35% of all angioplasties. Stents—metal scaffold tubes that support arteries after balloon angioplasty—can be coated in a slow release drug to reduce restenosis, in which the artery becomes blocked again.
The sirolimus-eluting Cypher stent, the first to be approved in the US, was used in 35% of angioplasties in the nine months after its approval
Credit: CORDIS CORPORATION
Use of drug eluting stents rose rapidly, from 20% in the first quarter after its introduction to 45% in the third quarter. Plain metal stents, however, were more likely to be used in patients without health insurance, Native Americans, African-Americans, and patients who had had a coronary artery bypass graft.
Sunil Rao, assistant professor of medicine at Duke University Medical Center in Durham, North Carolina, reported that both drug eluting and plain metal stents were used in 83% of the 162 969 percutaneous coronary interventions done at 259 US sites from April 2003 (when the Cypher stent became available) to December 2003.
In an abstract presented at the meeting of the American Heart Association in New Orleans, Dr Rao and colleagues used multivariable logistic regression, including hospital, patient, and lesion characteristics, to determine predictors of drug eluting stents compared with plain metal stents.
The data were collected in a large multicentre national quality improvement initiative for cardiac catheterisation laboratories run by the American College of Cardiology's national cardiovascular disease registry. The college uses the data to generate a quality report that tells each centre how it compares with practices in the rest of the country, Dr Rao told the BMJ.
Dr Rao's study also found that low volume hospitals and government hospitals (mostly veterans' hospitals) were more likely to use plain metal stents. Bare metal stents were also likely to be used on patients who had received a stent as an emergency procedure, were in shock at presentation, or who had had an acute myocardial infarction in the 24 hours before a stent was fitted.
Elderly patients were more likely to have diffuse disease and to have arteries that were too small to use a stent and might receive bypass surgery, he said.
The drug eluting stent was almost twice as expensive as the plain metal one, although costs have come down, he said. Patients receiving a plain stent were usually prescribed aspirin and an expensive antiplatelet drug for one month afterwards; those receiving a drug eluting stent required the expensive drug for three to six months.
In a second study, Dr Rao found that the stents were used almost equally in approved clinical situations and in those not included in the initial indication—unapproved or "off-label" use. Unapproved uses included patients with a myocardial infarction, with complex lesions, and who had had restenosis with a previous stent.(Janice Hopkins Tanne)