Acceptance, Panic, and Partial Recovery The Pattern of Usage of Drug-Eluting Stents After Introduction in the U.S. (A Report From the American College of Cardiology/National Cardiovascular Data Registry)
Acceptance, Panic, and Partial Recovery The Pattern of Usage of Drug-Eluting Stents After Introduction in the U.S. (A Report From the American College of Cardiology/National Cardiovascular Data Registry)
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DOI：
10.1016/j.jcin.2010.06.014
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发表时间：
2010-09-01
影响因子：
11.3
通讯作者：
Weintraub, William S. m
中科院分区：
文献类型：
--
作者：
Krone, Ronald J.;Rao, Sunil V.;Weintraub, William S. m
目的回顾药物洗脱支架（DES）的使用，以评估其使用的变化。背景DES是在经过精心挑选的患者中进行的几项小型研究显示支架内再狭窄显著减少后获得批准的。然后，DES被迅速纳入日常实践。在2006年，3年后介绍，长期safety.Methods严重关切，我们询问了美国心脏病学会/国家心血管数据登记处（ACC/NCDR）导管PCI注册。对截至2009年中期使用DES的百分比进行了总体审查，并在按病变类型、临床因素、保险和医院特征分类的患者亚组中进行了审查。在3个相关时间间隔内构建了将这些协变量与DES使用率相关的多变量logistic模型。到2005年，超过90%的首次置入支架是DES。2006年出现的安全性问题将DES的使用减少到首次置入支架的64%。在2008年公布了有益的结果数据后，到2009年中期，使用率增加到76%。logistic模型显示DES在以下患者中使用的可能性降低：1）ST段抬高型心肌梗死; 2）无医疗保险。支架内再狭窄增加了DES的使用。医院的特点是没有相关的显着差异DES use.Conclusions DES在美国的临床实践中迅速通过。2006年对晚期支架血栓形成的关注显著改变了DES的使用，在血栓形成风险亚组和无保险患者中观察到减少。DES引入后的这些快速周期性变化加强了在引入新技术后持续、及时报告结局数据的必要性。（J Am科尔Cardiol Intv 2010;3：902-10）（C）美国心脏病学会基金会2010年
Objectives Review the use of drug-eluting stents (DES) to evaluate changes in use.Background The DES were approved after several small studies in carefully selected patients showed dramatic reduction in in-stent restenosis. The DES were then rapidly adopted into routine practice. In 2006, 3 years after introduction, serious concerns regarding long-term safety were raised.Methods We queried the American College of Cardiology/National Cardiovascular Data Registry (ACC/NCDR) CathPCI Registry. The percentage of DES used through mid-2009 was reviewed overall and in subgroups of patients categorized by lesion type, clinical factors, insurance, and hospital characteristics. Multivariable logistic models relating these covariates to DES usage were constructed for 3 relevant time intervals.Results A total of 2,247,647 coronary stent procedures were analyzed. By 2005 over 90% of first stents placed were DES. Safety concerns arising in 2006 reduced DES use to 64% of first stent placed. After publication of salutary outcomes data in 2008, usage increased to 76% by mid-2009. The logistic models demonstrated decreased likelihood of DES usage in patients with: 1) ST-segment elevation myocardial infarctions; and 2) no medical insurance. The DES usage increased for in-stent restenosis. Hospital characteristics were not associated with significant differences in DES usage.Conclusions There was rapid adoption of DES into U.S. clinical practice. Concern for late stent thrombosis in 2006 significantly altered DES use with reductions seen in subgroups at risk for thrombosis and patients with no insurance. These rapid cyclic changes after DES introduction reinforce the need for continuous, timely reporting of outcomes data after the introduction of new technologies. (J Am Coll Cardiol Intv 2010;3:902-10) (C) 2010 by the American College of Cardiology Foundation