Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras

Ryan, Jason; Linde-Zwirble, Walter T.; Engelhart, Luella; Cooper, Liesl M.; Cohen, David J.

doi:10.1161/circulationaha.108.781138

Cited by 49 publications

(31 citation statements)

References 44 publications

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“…Ryan and colleagues found no significant change in mortality between 2001 and 2004 among a large sample of Medicare beneficiaries who underwent revascularization; however, the inclusion criterion was coronary revascularization, not myocardial infarction. 34 Our discordant findings may reflect advances in overall management of acute coronary syndromes made in the past few years, with emphasis on the combination of effective medical therapies and invasive procedures, in addition to improved logistics of care. This hypothesis is supported by our observation of improvement in outcomes over time in spite of worsening comorbidity profiles.…”

Section: Researchmentioning

confidence: 92%

Temporal trends in revascularization and outcomes after acute myocardial infarction among the very elderly

Pagé¹,

Doucet²,

Eisenberg³

et al. 2010

Canadian Medical Association Journal

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Section: Researchmentioning

confidence: 92%

Temporal trends in revascularization and outcomes after acute myocardial infarction among the very elderly

Pagé¹,

Doucet²,

Eisenberg³

et al. 2010

Canadian Medical Association Journal

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“…14 Whether these events reflect progression of atherosclerosis or unrecognized ischemia at originally untreated sites, staging of complex PCI procedures, or complications arising from the drug-eluting stent itself (ie, restenosis or stent thrombosis [ST]) is not known. To address this question, we used data from the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry to evaluate the frequency, predictors, and timing of repeat revascularization, both planned and unplanned, during the first year after contemporary PCI.…”

Section: Editorial See P 746mentioning

confidence: 99%

Repeat Revascularization After Contemporary Percutaneous Coronary Intervention

Stolker

Cohen

Kennedy

et al. 2012

Circ: Cardiovascular Interventions

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Background-Although drug-eluting stents and intensive secondary prevention have contributed to improved outcomes after percutaneous coronary intervention (PCI), repeat revascularization remains relatively common in contemporary practice. We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events registry to evaluate the relative frequency and timing of staged revascularization, target lesion revascularization (TLR), and other nontarget revascularization during the first year after contemporary PCI. Methods and Results-Patients with staged revascularization, TLR, and other unplanned procedures (elsewhere in the target vessel or in other coronary arteries) were evaluated in time-dependent models using Kaplan-Meier life-table estimation.Predictors of TLR and unplanned revascularization at nontarget sites were identified using logistic regression. Between July 2004 to June 2007, 10 144 patients undergoing PCI were enrolled at 55 US hospitals, of whom 86% were treated with at least 1 drug-eluting stent. Twelve percent required repeat revascularization within the first year (3% staged; 9% unplanned). More than 75% of staged revascularizations were performed <30 days after index PCI, although there was significant variation in this practice across hospitals (range, 0%-54%). TLR occurred in 4.5% of patients, with higher hazard rates between 2 to 9 months after PCI, whereas the risk of unplanned non-TLR (4.4% cumulative incidence) was constant over time. Conclusions-Among unselected patients undergoing PCI in the drug-eluting stent era, the incidence of repeat revascularization at 1 year is ≈12%. Among unplanned procedures, only half are performed for TLR. To achieve further improvements in PCI outcomes, future efforts should concentrate as much on identifying ischemia-producing lesions and intensifying secondary prevention therapies as on the prevention of restenosis. (Circ Cardiovasc Interv. 2012;5:772-782.)

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“…Most studies examined data after the approval and marketing of DES (April 2003 in the U.S.), but a few studies compared outcomes before and after DES became available (22,25 strong selection bias for DES over BMS, with differences in many measured clinical characteristics and presumably many differences in unmeasured characteristics, such as likely adherence to antiplatelet therapy. Most studies used propensity score methods to control for selection bias evident from measured clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

The Year in Epidemiology, Health Services Research, and Outcomes Research

Hlatky

Heidenreich

2009

Journal of the American College of Cardiology

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Temporal Changes in Coronary Revascularization Procedures, Outcomes, and Costs in the Bare-Metal Stent and Drug-Eluting Stent Eras

Abstract: Background-Although drug-eluting stents have been shown to be cost-effective compared with bare-metal stents for select clinical trial patients, whether these findings apply to the general population is unknown.

Cited by 49 publications

References 44 publications

Temporal trends in revascularization and outcomes after acute myocardial infarction among the very elderly

Temporal trends in revascularization and outcomes after acute myocardial infarction among the very elderly

Repeat Revascularization After Contemporary Percutaneous Coronary Intervention

The Year in Epidemiology, Health Services Research, and Outcomes Research

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