Abstract 14761: Impact of Individualized Restenosis Risk Estimates on Medical Decision Making during PCI
Background: Restenosis is an important complication of percutaneous coronary intervention (PCI) that is both predictable and modifiable. Although the benefit of drug eluting stents (DES) in reducing restenosis is dependent on a patient’s restenosis risk, evidence suggests that restenosis risk has little impact on stent selection during PCI. PRISM is a tool that generates individualized risk estimates at the time of PCI to support medical decision-making. In a pre-post study design, we examined whether PRISM-generated restenosis risk estimates influenced the utilization of DES during PCI at 9 U.S. hospitals.
Methods: Individualized restenosis risk estimates for patients undergoing PCI were calculated by incorporating the previously validated MASS-DAC restenosis risk model into the PRISM software platform. Patients were stratified according to low (<10%), intermediate (10-30%), or high (>30%) risk for restenosis. DES utilization before and after PRISM implementation was compared. Propensity-adjusted odds ratios were calculated for DES use after PRISM implementation within strata of restenosis risk, after hierarchical modeling to adjust for physicians’ case volumes.
Results: There were 6,312 PCI procedures performed in the 12 months prior to PRISM implementation, and 3,027 procedures performed after implementation (mean exposure time 9.3 months). Patients were estimated to be at low risk for restenosis in 34% of cases, at intermediate risk in 59% of cases, and at high risk in 7% of cases. DES were utilized in 77% of all PCI procedures prior to PRISM implementation, and in 78% of cases following implementation. The odds ratios for DES use after PRISM implementation were 1.13, 0.97, and 1.19 (p=0.56 for trend) in patients at low, intermediate and high restenosis risk, respectively.
Conclusions: Individualized restenosis risk estimates had no discernible impact on the utilization of drug eluting stents at 9 U.S. PCI centers. Further research is necessary to identify and overcome barriers to the incorporation of clinical risk estimates in medical decision making.
- © 2012 by American Heart Association, Inc.