Abstract 11524: Preferential Use of Bare Metal Over Drug Eluting Stents in Primary Percutaneous Coronary Intervention: Can We Afford Current European Guidelines Recommendations?
DES reduce TLR risk compared to BMS in primary percutaneous coronary intervention (PPCI), with no benefit in mortality, and are currently recommended as first line therapy by the ESC guidelines. In the current era of budget constraints, proper selection of pts who may truly benefit from DES implantation is important. This study aims to evaluate the clinical outcomes of pts undergoing PPCI with a predetermined strategy of preferential use of BMS over DES.
Methods: We retrospectively analyzed 283 consecutive STEMI pts (63±13 years) referred to our institution for PPCI (2007-2013). Hospital protocol recommended default BMS utilization, although it allowed DES implantation at operator’s discretion if the lesion was deemed to have a high restenosis risk. Pts were retrospectively allocated in three groups: Group 1 (n=112, 39.5%) BMS in lesions without a high restenosis risk, Group 2 (n=123, 43.5%) BMS in lesions with a high restenosis risk and Group 3 (n=48, 17%) DES implantation. Mean follow-up was 31± 19 months. Only 2 pts were lost to follow-up.
Results: Pts in Groups 2 and 3 had a higher prevalence of diabetes, and pts in Group 3 had a higher prevalence of previous MI. Rates of death, myocardial infarction and stroke were similar among groups. TLR rate was higher in Group 2 (10.7%) vs. Group 1 (2.7%) and 3 (4.2%); p 0.03. Pts treated with BMS (Groups 1 and 2 combined) had a 6.8% TLR rate vs. 4.2% in pts treated with DES (Group 3, p=0.4). Although stent prizes vary among countries, estimating a cost of 500 $ per BMS and 1,000 $ for DES, the cost of a strategy of routine DES utilization in our cohort would have been 283,000 $ instead of the actual 165.500 $ (Δ 117.500 $, 41% savings). Even if only pts with low restenosis risk (Group 1) had been treated with BMS the cost would have been 227.000 $ (Δ 56.000 $ 19.7% savings). DES utilization in Group 1 might have reduced TLR rates but the low figure observed in our cohort (2.7%) indicates that this strategy may not be cost-effective.
Conclusions: In pts undergoing PPCI, a strategy of preferential use of BMS showed excellent clinical results and led to important cost savings. In the current era of cost-effectiveness and budget restrictions BMS should be considered at least in pts with a priori low restenosis risk.
Author Disclosures: A. Núñez García: None. J. Botas Rodriguez: None. L.A. Inga Ayac: None. R. Del Castillo Medina: None. L. Hernando Marrupe: None. D. Adriana: None. J. Alonso Bello: None. M. Chichakli Cela: None.
- © 2016 by American Heart Association, Inc.