| Clinical and economic outcomes after introduction of drug-eluting stents. | |
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MedLine Citation:
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PMID: 20712391 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In clinical trials, drug-eluting stents (DES) improve clinical outcomes but are more expensive than bare-metal stents (BMS). OBJECTIVE: To assess clinical and economic outcomes of all percutaneous coronary intervention (PCI) procedures in a general interventional cardiology practice before and after DES introduction in 2003. METHODS: We identified all patients undergoing PCI in 2000-2002 (early cohort, pre-DES era) and from 2004 through April 31, 2006 (late cohort, DES era) in a large PCI registry. Logistic and Cox proportional hazard models estimated the risk of adverse events; generalized linear modeling predicted economic outcomes. RESULTS: We compared 4303 early-cohort patients with 3422 late-cohort patients. Most early-cohort patients (90%) had BMS implanted; the rest had atherectomy or balloon angioplasty only. Among late-cohort patients, 83% had DES, 14% BMS, and 6% balloon angioplasty or atherectomy only. In-hospital adverse-event rates and incidence of death or myocardial infarction (during a median follow-up of 22 months) were similar. Follow-up procedures were significantly fewer in the later era (hazard ratio for target lesion revascularization: 0.58; 95% confidence interval [CI], 0.50-0.68). Although catheterization lab supply costs were higher in the DES era, length of stay following index PCI and overall practice costs were reduced, on average, 0.40 days and $2053 in the late cohort (95% bootstrapped CI of adjusted mean difference, -$2937 to -$1197). Follow-up cardiac hospitalization costs were similar at 1 year. CONCLUSIONS: Patients undergoing PCI following DES introduction experienced improved clinical outcomes during follow-up and reduced overall procedural costs, despite higher stent acquisition costs. |
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Authors:
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Charanjit S Rihal; James L Ryan; Mandeep Singh; Ryan J Lennon; John F Bresnahan; Juliette T Liesinger; Bernard J Gersh; Henry H Ting; David R Holmes; Kirsten Hall Long |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The American journal of managed care Volume: 16 ISSN: 1936-2692 ISO Abbreviation: Am J Manag Care Publication Date: 2010 Aug |
Date Detail:
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Created Date: 2010-08-17 Completed Date: 2011-01-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9613960 Medline TA: Am J Manag Care Country: United States |
Other Details:
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Languages: eng Pagination: 580-7 Citation Subset: H |
Affiliation:
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Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. rihal@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon, Coronary
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economics*,
statistics & numerical data Cohort Studies Confidence Intervals Coronary Restenosis / drug therapy*, mortality, therapy Drug-Eluting Stents / economics*, statistics & numerical data Female Health Care Costs Humans Kaplan-Meier Estimate Length of Stay Logistic Models Male Models, Economic Proportional Hazards Models Registries Retrospective Studies Risk Factors Treatment Outcome United States |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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