Changing treatment patterns for coronary artery revascularization in Canada: the projected impact of drug eluting stents.
BACKGROUND
To evaluate current treatment patterns for coronary artery revascularization in Canada and explore the potential impact of drug eluting stents (DES) on these treatment patterns.


METHODS
Eleven cardiologists at multiple Canadian academic centers completed a questionnaire on coronary artery revascularization rates and treatment patterns.


RESULTS
Participating physicians indicated slightly higher rates of PTCA, CABG, and stent implantation than reported in CCN publications. Participants estimated that 24% of all patients currently receiving bare metal stents (BMS) would receive DES in the first year following DES approval in Canada, although there was a large range of estimates around this value (5% to 65%). By the fifth year following DES approval, it was estimated that 85% of BMS patients would instead receive DES. Among diabetic patients, estimates ranged from 43% in the first year following approval to 91% in the fifth year. For all patients currently receiving CABG, mean use of DES instead was estimated at 12% in the first year to 42% at five years; rates among diabetic patients currently undergoing CABG were 17% in the first year to 49% in the fifth year.


CONCLUSIONS
These results suggest a continued increase in revascularization procedures in Canada. Based on the panel's responses, it is likely that a trend away from CABG towards PTCA will continue in Canada, and will be augmented by the availability of DES as a treatment option. The availability of DES as a treatment option in Canada may change the threshold at which revascularization procedures are considered.
Halpern
Michael T
MT
Exponent, Alexandria, VA, USA. mhalpern@exponent.com
Lacey
Michael
M
Clark
Mary Ann
MA
Valentin
Miguel A
MA
D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002170:Canada; D002309:Cardiology; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000191:economics / Q000628:therapy*; D018795:Device Approval; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D015607:Stents / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires