Stent Decisions Not Tied to Risk

Drug eluting stent choice not made based on reblockage risks

(RxWiki News) When deciding whether a patient will receive a drug-eluting stent to prop open blocked coronary arteries, it appears that the decision usually has little to do with future risk of reblockage.

The main goal of drug-eluting stents is to prevent clogged coronary arteries from becoming blocked on another occasion.

However, a study found that 70 percent of patients at low risk of reblockage received a drug-eluting stent.

"Talk to your cardiologist about stent options."

Robert Yeh, MD, MSc, of the Massachusetts General Hospital Heart Center, the study's corresponding author, said that while procedures to implement stents can save lives during a heart attack and improve quality of life, more sensible selection by reblockage risk could lead to substantial cost savings, while having a minimal impact on the outcome of patients.

After receiving a drug-eluting stent, patients take anti-clotting medication for at least a year, which increases their risk of bleeding, which potentially outweighs the small risk of harm that comes from receiving the actual stent. Drug-eluting stents are coated with medication that helps prevent tissue from growing around the stent.

Researchers analyzed treatment data from 1.5 million angioplasty patients at more than 1,100 U.S. hospitals between January 2004 and September 2010. Of these patients, 13 percent were at high risk of reblockage, while 44 percent had a moderate risk and the remainder were classified as low risk.

Of the participants, 77 percent received drug-eluting stents, including 83 percent of high-risk patients, 78 percent of moderate-risk patients and 74 percent of low-risk patients. Doctor usage of drug-eluting stents varied with some rarely using them, while others almost always used them.

Investigators calculated that reducing the use of drug-eluting stents by half in low-risk patients could result in more than $200 million in U.S. healthcare cost savings each year. They also suggest doctors more frequently opt for bare metal stents, which requires only a month of anti-clotting drugs, in patients who are candidates.

"The critical challenge in using stents is to be sure the decision reflects the patient's preference, rather than the physician's," said co-author John Spertus, MD, MPH, clinical director of Outcomes Research at Saint Luke’s Mid America Heart Institute. "If half the patients who find they are at low risk for restenosis (reblockage) choose bare metal stents to avoid the costs, bleeding risk and other complications associated with dual anti-platelet therapy, we could generate significant savings while better respecting patients' preferences."

The study was recently published in journal Archives of Internal Medicine.

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Review Date: 
July 12, 2012