Abstract 3992: Effect of Insurance Status on Use of Drug Eluting Stents versus Bare Metal Stents in Patients Undergoing Elective PCI
Background: Drug eluting stents (DES) have revolutionized the practice of interventional cardiology due to their favorable influence on restenosis. We explored potential economic disparities in DES use by examining the relationship between patients’ insurance status and the placement of DES versus bare metal stents (BMS) in a large PCI registry.
Methods: We analyzed all patients who underwent elective coronary stenting in the ACC-NCDR Cath/PCI registry between 2004–2005. Insurance status was categorized as None, Governmental, and Private. A logistic regression model was developed, including baseline demographic and clinical characteristics that differed by insurance status. Secondary analysis using a hierarchical model with site as a random effect was done to account for the potential influence of site on insurance status and DES use.
Results: Of 114,015 patients analyzed, 49,339 had Private, 61,634 had Government, and 2,997 had No insurance. Data were available for 4,322 with BMS and 109,693 with DES. Patients with No insurance were less likely than Private insurance to receive a DES (OR=0.56, (0.48 – 0.66, 95% CI)), and Private insurance patients were more likely (OR=1.54 (1.42–1.67, 95% CI)) to receive a DES than those with Government insurance. Hierarchical analysis confirmed these results after accounting for site (Ors=0.60 (0.50 – 0.72) and 1.35 (1.24–1.47), respectively).
Conclusions: While the use of BMS has fallen dramatically, the use of DES is not uniform across socioeconomic strata. Patients with Private insurance are more likely to receive DES than those with Government or No insurance. This apparent disparity in care delivery warrants further investigation.