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Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry).

Publication ,  Journal Article
Rymer, JA; Harrison, RW; Dai, D; Roe, MT; Messenger, JC; Anderson, HV; Peterson, ED; Wang, TY
Published in: Am J Cardiol
October 1, 2016

In 2006, the United States (US) Food and Drug Administration published advisory highlighting concerns for late drug-eluting stent thrombosis; its impact on US bare-metal stent (BMS) utilization is unknown. We examined rates of BMS use among Medicare patients at 946 US hospitals in the CathPCI Registry who underwent percutaneous coronary intervention (PCI) during 3 periods: (1) 2004 to 2006 preadvisory (n = 166,458); (2) 2007 to 2008 postadvisory (n = 216,318); and (3) 2012 to 2014 contemporary (n = 827,948). We examined predicted risks of target vessel revascularization and bleeding among BMS recipients by period. We compared 1-year repeat revascularization and death/myocardial infarction risks among BMS recipients immediately preadvisory and postadvisory. BMS were used in 15.8% of preadvisory, 40.9% of postadvisory, and 20.0% of contemporary PCI procedures. Although 19.5% of preadvisory BMS patients had a predicted target vessel revascularization risk ≥15%/year, this decreased to 16.7% postadvisory (p <0.001), and increased back to 18.7% among contemporary BMS recipients (p <0.001). In contrast, 12.3% of preadvisory BMS recipients had a predicted bleeding risk ≥5%/year, compared with 14.6% postadvisory (p <0.001), and 18.2% in contemporary BMS recipients (p <0.001). Postadvisory BMS recipients had a lower risk of repeat revascularization (12.8% vs 14.6%, adjusted hazard ratio 0.87, 95% CI 0.84 to 0.90) but no difference in the composite risk of death/myocardial infarction (15.9% vs 15.9%, adjusted hazard ratio 0.97, 95% CI 0.93 to 1.00). In conclusion, a surge in BMS use after the advisory was not associated with an increased risk of repeat revascularization or adverse outcomes in BMS-treated patients. One in 5 contemporary PCI procedures still involve BMS implantation.

Duke Scholars

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 1, 2016

Volume

118

Issue

7

Start / End Page

959 / 966

Location

United States

Related Subject Headings

  • United States Food and Drug Administration
  • United States
  • Thrombosis
  • Stents
  • Registries
  • Proportional Hazards Models
  • Postoperative Hemorrhage
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization
 

Citation

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Rymer, J. A., Harrison, R. W., Dai, D., Roe, M. T., Messenger, J. C., Anderson, H. V., … Wang, T. Y. (2016). Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry). Am J Cardiol, 118(7), 959–966. https://doi.org/10.1016/j.amjcard.2016.06.061
Rymer, Jennifer A., Robert W. Harrison, David Dai, Matthew T. Roe, John C. Messenger, H Vernon Anderson, Eric D. Peterson, and Tracy Y. Wang. “Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry).Am J Cardiol 118, no. 7 (October 1, 2016): 959–66. https://doi.org/10.1016/j.amjcard.2016.06.061.
Rymer JA, Harrison RW, Dai D, Roe MT, Messenger JC, Anderson HV, et al. Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry). Am J Cardiol. 2016 Oct 1;118(7):959–66.
Rymer, Jennifer A., et al. “Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry).Am J Cardiol, vol. 118, no. 7, Oct. 2016, pp. 959–66. Pubmed, doi:10.1016/j.amjcard.2016.06.061.
Rymer JA, Harrison RW, Dai D, Roe MT, Messenger JC, Anderson HV, Peterson ED, Wang TY. Trends in Bare-Metal Stent Use in the United States in Patients Aged ≥65 Years (from the CathPCI Registry). Am J Cardiol. 2016 Oct 1;118(7):959–966.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 1, 2016

Volume

118

Issue

7

Start / End Page

959 / 966

Location

United States

Related Subject Headings

  • United States Food and Drug Administration
  • United States
  • Thrombosis
  • Stents
  • Registries
  • Proportional Hazards Models
  • Postoperative Hemorrhage
  • Postoperative Complications
  • Percutaneous Coronary Intervention
  • Myocardial Revascularization