title: Drug-eluting stents for off-label indications in real clinical world: evidence based or 'intuition' based clinical practice?
abstract: BACKGROUND
  The use of drug-eluting stents (DES) is an example of the disparity between recommendations given by regulatory agencies and the real clinical world. Such disparity might lead cardiologists to adopt different routines in the use of DES. We aimed to assess variability of off-label DES use between hospitals and to what extent it can be explained by differences in patient or hospital characteristics.
  
  
  METHODS
  Characteristics of consecutive patients receiving DES in 29 hospitals were recorded. Individual and hospital determinants of receiving DES for off-label indications were assessed by multilevel logistic regression.
  
  
  RESULTS
  1903 patients were recruited and 1188 (62.4%) received DES for off-label indications. Individual variables associated with off-label use were age (OR 1.01 (1-1.02)), previous percutaneous (OR 2.24 (1.68-2.97)) or surgical (2.41 (1.52-3.84)) revascularization, repeated procedure at the same admission (OR 4.66 (2.7-8.05)), receiving two (OR 4.17 (3.24-5.37)) or three or more DES (OR 14.12 (9.08-21.96)) vs one. Adjusting for individual variables, the Odds of receiving DES for off-label indication was higher in public funding hospitals with surgery availability vs private hospitals: 1.49 (0.86-2.6), and in public hospitals without surgery vs public with surgery availability: OR 1.76 (1.02-3.03). Interhospital variability reminded significant after adjustment for individual and contextual variables.
  
  
  CONCLUSIONS
  Off-label DES use is highly variable between centers. Although this variability is partially determined by hospital type of funding and cardiac surgery availability, the substantial interhospital variability after multilevel adjustment suggests heterogeneity in the process of care.
authors: Cardiology Department, Àrea del Cor. University Hospital Vall d'Hebron Barcelona, Spain. aribera@vhebron.net
authors: Aida
authors: A
authors: Ribera
authors: Ignacio
authors: I
authors: Ferreira-González
authors: Bruno García
authors: BG
authors: Del Blanco
authors: Josep R
authors: JR
authors: Marsal
authors: Purificación
authors: P
authors: Cascant
authors: Gerard
authors: G
authors: Martí
authors: Angel R
authors: AR
authors: Cequier
authors: Joan Antoni
authors: JA
authors: Gómez-Hospital
authors: Eduard
authors: E
authors: Fernandez-Nofrerías
authors: Xavier
authors: X
authors: Carrillo
authors: M Carmen
authors: MC
authors: López-Pérez
authors: Josep
authors: J
authors: Navarro
authors: Rafael
authors: R
authors: Raso
authors: David
authors: D
authors: García-Dorado
authors: Gaietà
authors: G
authors: Permanyer-Miralda
mesh_terms: D000368:Aged; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis