Coronary stent use in New York State in the drug-eluting stent era

Abstract

Objectives: The drug-eluting stent (DES) was perceived as a revolutionary medical technology because of the lower risk of restenosis compared with bare metal stent (BMS). However, the safety of DES use was called into question in 2006 due to increased incidence of catastrophic late stent thrombosis. This study aims to describe coronary stent use in the DES era in New York State.

Methods: Using New York State statewide hospital discharge database, we conducted descriptive analysis and logistic regression to examine the independent impacts of the introduction of DES and of the DES safety concern on DES utilization, controlling for patient demographics, co-morbidities and hospital effects.

Results: In the first year following the introduction of DES technology, there was a 10-fold increase in the odds of DES use versus BMS use (AOR: 10.86, 95% CI: 9.84-11.99, P < 0.001). When the safety of DES use was called into question, the odds of DES utilization decreased by 75% over a 9-month period (AOR: 0.23, 95% CI: 0.20-0.26, P < 0.001).

Conclusions: Following the introduction of DES, there was a rapid adoption of DES by interventional cardiologists, followed by a rapid abandonment of DES when significant safety issues were raised. After the safety of DES was called into question, there was a reduction in the use of DES and in the use of stents in general.