Use of drug-eluting stents in Victorian public hospitals.
OBJECTIVE
We aimed to assess the pattern of use of drug-eluting stents (DESs) in patients undergoing percutaneous coronary interventions (PCIs) in Victorian public hospitals.


METHODS
Prospective study comparing the use of one or more DESs versus bare-metal stents (BMSs) only, in consecutive patients undergoing 2428 PCIs with stent implantation from 1 April 2004 to 31 December 2005 at seven Victorian public hospitals.


METHODS
Adherence to current Victorian Department of Human Services guidelines which recommend DES use in patients with high-risk features for restenosis (diabetes, small vessels, long lesions, in-stent restenotic lesions, chronic total occlusions and bifurcation lesions).


RESULTS
Of the 2428 PCIs performed, at least one DES was implanted in 1101 (45.3%) and BMSs only were implanted in 1327 (54.7%). In 87.7% (966/1101) of PCI with DESs, there was at least one criterion for high risk of restenosis. DESs were more likely to be used in patients with diabetes (risk ratio [RR], 2.45; 95% CI, 2.02-2.97), small vessels (RR, 3.35; 95%CI, 2.35-4.76), long lesions (RR, 3.87; 95% CI, 3.23-4.65), in-stent restenotic lesions (RR, 3.98; 95%CI, 2.67-6.06), chronic total occlusions (RR, 1.30; 95% CI, 0.51-2.88) and bifurcation lesions (RR, 2.23; 95%CI, 1.57-3.17). However, 66.2% (1608/2428) of all PCIs were in patients eligible for DESs according to Victorian guidelines, and in 39.9% (642/1608) of these PCIs, a BMS was used.


CONCLUSIONS
In Victorian public hospitals, DESs have been largely reserved for patients at high risk of restenosis in accordance with Department of Human Services guidelines. However, many patients with high-risk criteria for restenosis did not receive DESs. Greater use of DESs in these patients may improve outcomes by reducing the need for repeat revascularisation.
Yan
Bryan P
BP
Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Ajani
Andrew E
AE
Duffy
Stephen J
SJ
New
Gishel
G
Horrigan
Mark
M
Szto
Gregory
G
Walton
Antony
A
Eccleston
David
D
Lefkovits
Jeffery
J
Black
Alexander
A
Sebastian
Martin
M
Brennan
Angela L
AL
Reid
Christopher M
CM
Clark
David J
DJ
D015906:Angioplasty, Balloon, Coronary; D023903:Coronary Restenosis / Q000517:prevention & control*; D016503:Drug Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012306:Risk; D015607:Stents / Q000706:statistics & numerical data*; D014600:Utilization Review; D014739:Victoria