Feasibility and cost of treatment with drug eluting stents of surgical candidates with multi-vessel coronary disease.
OBJECTIVE
To determine the feasibility and cost of treatment with drug eluting stents in patients with multi-vessel coronary disease referred currently for surgical revascularisation.


METHODS
Two experienced interventional cardiologists reviewed retrospectively the clinical records and pre-operative coronary angiograms of 209 patients who underwent their first coronary bypass operation for multi-vessel disease without other adjunctive surgical procedures at the Royal Brompton Hospital in 2002. They were classified according to the technical feasibility and completeness of percutaneous revascularisation. A cost decision-analysis model with a cost of drug eluting stents of euro 2,100 and simulated 1-year costs was constructed.


RESULTS
Mean age was 64.6+/-8.9 years with 54 diabetics (25.8%). Each patient received at least 1 arterial graft and a mean of 3.0+/-0.8 distal anastomoses. Mean post-operative stay was 8.9+/-7.2 days and total cost euro 19,821+/-1,964. Percutaneous revascularisation was judged to be feasible in 158 (76%) cases. The contraindications were at least 1 unfavourable total occlusion subtending viable myocardium in 48 patients (23%) and extreme tortuosity or calcification in 4 patients (2%). Percutaneous revascularisation of grafted major epicardial vessels was anticipated to be complete in 138 (66%) patients and partial but acceptable in 19 (9.1%) patients. Stenting of the left main, of a 'favourable' total occlusion, of bifurcations or in an ostial location would have been required in 32 (20.4%), 60 (38.2%), 77 (49.0%) and 74 (47.1%), respectively, of cases treated. 3.6+/-1.4 drug eluting stents of total length 72.6+/-37.3 mm were required to treat 3.3+/-1.2 lesions per patient at an estimated cost of euro 17,266+/-2,850. When one year repeat revascularisation was modelled at a rate of 15% in the stent group there was no significant cost saving from stenting.


CONCLUSIONS
Although percutaneous revascularisation is feasible in 76% of patients currently undergoing coronary artery bypass grafting for multi-vessel disease, such an approach will involve frequent treatment of complex lesions for which no long term results are available and is unlikely to provide appreciable economic savings.
Griffiths
Huw
H
Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
Bakhai
Ameet
A
West
Douglas
D
Petrou
Mario
M
De Souza
Tony
T
Moat
Neil
N
Pepper
John
J
Di Mario
Carlo
C
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000191:economics*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004343:Drug Implants / Q000191:economics; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*
D004343:Drug Implants