Patterns and outcomes of drug-eluting coronary stent use in clinical practice.
OBJECTIVE
To determine patterns and outcomes of drug-eluting stents (DES) use in clinical practice.


BACKGROUND
DES are technology associated with superior outcomes. The initial limited availability and high cost of DES had the potential to influence their use.


METHODS
Data from the American College of Cardiology-National Cardiovascular Data Registry were examined to describe the patterns of DES use in 408,033 percutaneous coronary intervention (PCI) procedures at 383 sites. Predictors of DES use were determined, and inhospital outcomes were examined.


RESULTS
From April 2003 through December 2004, the proportion of procedures using DES increased from 19.7% to 78.2%. DES use increased across all patient groups and hospital types, but adoption was slower among older patients and those without health insurance. DES use varied among hospitals such that use was lower at rural and low-volume hospitals. Multivariable regression demonstrated a progressive decrease in the odds of DES use as age increased. White race, female sex, presence of insurance, diabetes mellitus, PCI of de novo lesion, PCI at a high volume center, and PCI at a suburban hospital were significant predictors of DES use. The availability of a second DES product did not influence the adoption patterns. Inhospital outcomes with DES were excellent.


CONCLUSIONS
Access to DES was influenced by demographic, socioeconomic, and hospital characteristics. Further study is needed to determine if the availability of another DES platform or increased overall availability of DES impacts favorably on PCI practice patterns.
Rao
Sunil V
SV
The Duke Clinical Research Institute, Durham, NC 27705, USA. sunil.rao@duke.edu
Shaw
Richard E
RE
Brindis
Ralph G
RG
Klein
Lloyd W
LW
Weintraub
William S
WS
Krone
Ronald J
RJ
Peterson
Eric D
ED
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000628:therapy; D016503:Drug Delivery Systems; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012042:Registries; D015607:Stents / Q000191:economics / Q000706:statistics & numerical data*; D016019:Survival Analysis
D002317:Cardiovascular Agents