Abstract 2469: Rational Use of Drug-Eluting Stents: Modeling and Implementation of a Pre-Procedural Risk Stratification Algorithm
Purpose: Drug-eluting stents (DES) are increasingly used in coronary interventions. However, the widespread use is limited by higher costs and uncertainty regarding late fatal events due to stent thrombosis. Aim of this study was to develop and implement a pre-procedural risk stratification chart for a rational and efficient use of DES.
Methods: Established and validated tables for pre-procedural restenosis risk estimation based on reference diameter and lesion length were used. Cut-off values in favor of DES implantation for non-diabetic (light grey) and diabetic patients (dark grey) were defined based on an anticipated restenosis rate of 20% or more with bare-metal stents (BMS). Numbers and dimensions of all DES and BMS implanted between 01/2004- 08/2005 in our center were analysed, transferred and superimposed in the reference tables. The distribution of DES indications was retrospectively analysed.
Results: A total of 2784 stents were implanted during the observation period (493 DES, 17.7%). Of these a total of 280 DES (57%) were implanted in lesions with a low restenosis-risk (<15%).
Conclusions: Analysis of the stent length/diameter distribution combined with the use of validated restenosis reference charts allows identification of high-risk patients regarding restenosis risk and modeling the use of DES depending on financial resources and long term risks. Such algorithm provides the rational for a risk stratification and, therefore, an efficiant use of resources. Total number of implanted stents, DES in bold, restenosis risk in percent(%)