Document Detail

Evaluating the effectiveness of a rapidly adopted cardiovascular technology with administrative data: the case of drug-eluting stents for acute coronary syndromes.
MedLine Citation:
PMID:  22877806     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Instrumental variable (IV) methods can correct for unmeasured confounding when using administrative (claims) data for cardiovascular outcomes research, but difficulties identifying valid IVs have limited their use. We evaluated the safety and efficacy of drug-eluting coronary stents (DES) compared with bare-metal stents (BMS) for Medicare beneficiaries with acute coronary syndromes using the rapid uptake of DES in clinical practice as an instrument. We compared results from IV with those from propensity score matching (PSM) and multivariable regression models.
METHODS: This is a retrospective cohort study involving 62,309 fee-for-service beneficiaries 66 years and older treated with coronary stenting between May 2003 and February 2004. Outcomes were measured for 46 months after revascularization using claims data.
RESULTS: Recipients of DES were younger, had a lower prevalence of myocardial infarction, and had fewer comorbidities compared with BMS recipients. Use of DES was associated with lower rates of mortality by PSM (hazard ratio [HR] 0.80, CI 0.77-0.83) but not by IV (HR 0.99, CI 0.87-1.11). Instrumental variable models estimated a larger reduction in repeat revascularization (HR 0.76, CI 0.63-0.89) than did PSM (HR 0.90, CI 0.87-0.93).
CONCLUSIONS: Based on IV analysis, the increased utilization of DES relative to BMS among Medicare beneficiaries with acute coronary syndrome is associated with reduced rates of repeat revascularization and no difference in mortality. Instrumental variable approaches provide a useful complement to conventional approaches to cardiovascular outcomes research with administrative data.
Jerome J Federspiel; Sally C Stearns; Brett C Sheridan; Jack J Kuritzky; Laura P D'Arcy; Daniel J Crespin; Timothy S Carey; Joseph S Rossi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  164     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-10     Completed Date:  2012-10-10     Revised Date:  2014-10-10    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  207-14     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mosby, Inc. All rights reserved.
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MeSH Terms
Acute Coronary Syndrome / therapy*
Aged, 80 and over
Cohort Studies
Drug-Eluting Stents / statistics & numerical data*
Logistic Models
Multivariate Analysis
Propensity Score
Prosthesis Implantation
Retrospective Studies
Stents / statistics & numerical data
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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