Open AccessImpact of stent diameter and length on in‐stent restenosis after DES vs BMS implantation in patients needing large coronary stents—A clinical and health‐economic evaluation
Author(s) -
Zbinden Rainer,
Felten Stefanie,
Wein Bastian,
Tueller David,
Kurz David J.,
Reho Ivano,
Galatius Soren,
Alber Hannes,
Conen David,
Pfisterer Matthias,
Kaiser Christoph,
Eberli Franz R.
Publication year - 2017
Publication title -
cardiovascular therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.818
H-Index - 46
eISSN - 1755-5922
pISSN - 1755-5914
DOI - 10.1111/1755-5922.12229
Subject(s) - medicine , restenosis , stent , target lesion , population , coronary arteries , drug eluting stent , surgery , percutaneous coronary intervention , artery , myocardial infarction , environmental health
Summary Aims The British National Institute of Clinical Excellence ( NICE ) guidelines recommend to use drug‐eluting stents ( DES ) instead of bare‐metal stents ( BMS ) only in lesions >15 mm in length or in vessels <3 mm in diameter. We analyzed the impact of stent length and stent diameter on in‐stent restenosis ( ISR ) in the BASKET ‐ PROVE study population and evaluated the cost‐effectiveness of DES compared to BMS . Methods/Results The BASKET ‐ PROVE trial compared DES vs BMS in large coronary arteries (≥3 mm). We calculated incremental cost‐effectiveness ratios ( ICER s) and cost‐effectiveness acceptability curves with regard to quality‐adjusted life years ( QALY s) gained and target lesion revascularizations ( TLR s) avoided. A total of 2278 patients were included in the analysis. A total of 74 ISR in 63 patients were observed. In‐stent restenosis was significantly more frequent in segments treated with a BMS compared to segments treated with a DES (5.4% vs 0.76%; P <.001). The benefit of a DES compared to a BMS regarding ISR was consistent among the subgroups of stent length >15 mm and ≤15 mm, respectively. With the use of DES in short lesions, there was only a minimal gain of 0.005 in QALY s. At a threshold of 10 000 CHF per TLR avoided, DES had a high probability of being cost‐effective. Conclusion In the BASKET ‐ PROVE study population, the strongest predictor of ISR is the use of a BMS , even in patients in need of stents ≥3.0 mm and ≤15 mm lesion length and DES were cost‐effective. This should prompt the NICE to reevaluate its recommendation to use DES instead of BMS only in vessels <3.0 mm and lesions >15 mm length.