Coronary stent use in New York State in the drug-eluting stent era
ABSTRACT 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.
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.
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).
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.
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ABSTRACT: This paper seeks to provide a framework for understanding differential access to medical care in the U.S. population and to suggest ways to achieve equity of access. The framework is provided by a behavioral model of health services utilization which suggests a sequence of predisposing, enabling and illness variables that determine the number of times people will visit a physician. The model is operationalized using a path analytic technique. The data come from a national survey of the noninstitutionalized U.S. population conducted in late 1975 and early 1976. The results suggest services are generally equitably distributed since age and level of illness are the main determinants of the number of services people receive. However, remaining inequities might be reduced by providing people who report no regular source of medical care with a familiar entry into the health service system.Medical Care 08/1978; 16(7):533-46. DOI:10.1097/00005650-197807000-00001 · 2.94 Impact Factor
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ABSTRACT: Early clinical studies demonstrated the feasibility of local paclitaxel delivery in reducing restenosis after treatment of de novo coronary lesions in small patient populations. We conducted a randomized, double-blind trial of 536 patients at 38 medical centers evaluating slow-release (SR) and moderate-release (MR) formulations of a polymer-based paclitaxel-eluting stent (TAXUS) for revascularization of single, primary lesions in native coronary arteries. Cohort I compared TAXUS-SR with control stents, and Cohort II compared TAXUS-MR with a second control group. The primary end point was 6-month percent in-stent net volume obstruction measured by intravascular ultrasound. Secondary end points were 6-month angiographic restenosis and 6- and 12-month incidence of major adverse cardiac events, a composite of cardiac death, myocardial infarction, and repeat revascularization. At 6 months, percent net volume obstruction within the stent was significantly lower for TAXUS stents (7.9% SR and 7.8% MR) than for respective controls (23.2% and 20.5%; P<0.0001 for both). This corresponded with a reduction in angiographic restenosis from 17.9% to 2.3% in the SR cohort (P<0.0001) and from 20.2% to 4.7% in the MR cohort (P=0.0002). The incidence of major adverse cardiac events at 12 months was significantly lower (P=0.0192) in the TAXUS-SR (10.9%) and TAXUS-MR (9.9%) groups than in controls (22.0% and 21.4%, respectively), predominantly because of a significant reduction in repeat revascularization of the target lesion in TAXUS-treated patients. Compared with a bare metal stent, paclitaxel-eluting stents reduced in-stent neointimal formation and restenosis and improved 12-month clinical outcome of patients with single de novo coronary lesions.Circulation 09/2003; 108(7):788-94. DOI:10.1161/01.CIR.0000086926.62288.A6 · 14.95 Impact Factor