Coronary artery disease therapy －Drug-Eluting stent & Bare Metal Stent on Clinical Outcomes and Resources Utilization Analysis
Date Issued
2007
Date
2007
Author(s)
Cheng, Chia-Ling
DOI
zh-TW
Abstract
Purpose and Aim：Coronary artery disease (CAD) remains one of the most important health problems in the world. According to the statistical record from National Health Institute in Taiwan in 2005, the cardiovascular disease was the third leading cause of death; among them, the CAD was the major killer(event). The treatment of CAD has been proceeding since medical treatment, balloon angioplasty to coronary stents and resulted in major achievement. There are around ten thousand patients with CAD undergoing the implantation of coronary stents to keep adequate coronary blood flow every year.
The phenomenon of restenosis develops frequently after the implantation of traditional bare metal stents (BMS), and results in clinically-driven revascularization around 25-30%, and even up to 40% in diabetes patients. The repeated hospitalizations for percutaneous coronary intervention place great burden on patients as well as on the health care system. The object of our study is to elucidate the difference in clinical outcome and to demonstrate the cost-benefit between the two different types of stents (drug eluting stent (DES) and BMS).
Method：We retrospectively analyzed the clinical data and cost from patients undergoing coronary stenting from Sep. 2003 to Nov. 2004 in one tertiary-referring center. Patients presented with acute coronary syndrome initially and received BMS and DES at the same procedure were excluded.
Result: There were 226 patients enrolled in the DES group and 250 patients in the BMS group. The rate of target lesion revascularization (14.6% vs 24.4%, p=0.008), target vessel revascularizationwas (20.4% vs 28.4%, p=0.044) and major adverse cardiac events (20.8% vs 29.2%, p=0.044) were much lower in the DES group compared with that in the BMS group. DES group had a higher overall cost compared with BMS group (NT$363K ± 154K vs NT$319K ± 147K, p=0.002). The incremental cost-effectiveness ratio (ICER) to avoid a target vessel revascularization was NT$ 517K. In the subgroup analysis, the ICER showed better result in patient with diabetes or patient with triple vessel disease.
Conclusion: The use of DES resulted in lower rate of target vessel revascularization at two years. The cost-effectiveness did not favor BMS group. it will be more beneficial to use DES in selective patient groups such as patients with diabetes or triple vessel disease.
Subjects
冠狀動脈疾病
塗藥支架
傳統支架
Coronary artery disease
Drug-Eluting stent
Bare Metal Stent
SDGs
Type
thesis
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