Beyond restenosis: Patients' preference for drug eluting or bare metal stents.
OBJECTIVE
To assess patients' perspective about factors associated with stent choice.


BACKGROUND
Drug eluting stents (DES) markedly reduce the risk of repeat percutaneous coronary intervention (PCI), but necessitate a longer duration of dual anti-platelet therapy (DAPT) as compared with bare metal stents (BMS). Thus, understanding patients' perspective about factors associated with stent choice is paramount.


METHODS
Patients undergoing angiography rated, on a 10-point scale, the importance (1 = not important, 10 = most important) of avoiding repeat revascularization and avoiding the following potential DAPT drawbacks: bleeding/bruising, more pills/day, medication costs and delaying elective surgery. The factor, or group of factors, that was rated highest by each patient was identified.


RESULTS
Among 311 patients, repeat revascularization was the single most important consideration to 14.4% of patients, while 20.6% considered avoiding one of the DAPT drawbacks as most important. Most patients (65%) considered avoiding at least one DAPT drawback as important as avoiding repeat revascularization. In no subgroup of patients did more than a quarter of patients prefer avoiding repeat revascularization above all other concerns. Among patients undergoing PCI, more than three quarters received a DES, regardless of their stated preferences (DES use among those most valuing DES benefits, avoiding DAPT drawbacks, or both equally were 78.7%, 86.2%, and 85.6%, respectively, P = 0.56).


CONCLUSIONS
Most patients reported that avoiding DAPT drawbacks was as important as avoiding repeat revascularization. Eliciting patient preferences regarding stent type can enhance shared decision-making and allow physicians to better tailor stent choice to patients' goals and values.


BACKGROUND
Developing and Testing a Personalized Evidence-based Shared Decision-making Tool for Stent Selection (DECIDE-PCI). ClinicalTrials.gov Identifier: NCT02046902. URL: https://clinicaltrials.gov/ct2/show/NCT02046902 © 2017 Wiley Periodicals, Inc.
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Mohammed
http://orcid.org/0000-0002-6857-3206
M
Qintar
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Adnan K
AK
Chhatriwalla
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Suzanne V
SV
Arnold
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.
Fengming
F
Tang
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Donna M
DM
Buchanan
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Ali
A
Shafiq
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Yashashwi
Y
Pokharel
e-Patient Dave LLC and Society for Participatory Medicine, Newburyport, MA.
Dave
D
deBronkart
Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
Javed M
JM
Ashraf
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.|Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
John A
JA
Spertus
D000066491:Clinical Decision-Making; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D016527:Drug Costs; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008670:Metals; D008923:Missouri; D010358:Patient Participation; D057240:Patient Preference; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D011474:Prosthesis Design; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
D008670:Metals; D010975:Platelet Aggregation Inhibitors
dual anti-platelet therapy; patients’ preferences; percutaneous coronary intervention; shared decision-making