کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
2952465 1577422 2008 10 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Balancing the Risks of Restenosis and Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents : Results of a Decision Analytic Model
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی کاردیولوژی و پزشکی قلب و عروق
پیش نمایش صفحه اول مقاله
Balancing the Risks of Restenosis and Stent Thrombosis in Bare-Metal Versus Drug-Eluting Stents : Results of a Decision Analytic Model
چکیده انگلیسی

ObjectivesWe sought to define what incremental risk of very late stent thrombosis (VLST) in drug-eluting stents (DES) would outweigh the restenosis benefit.BackgroundAlthough there are robust data on the restenosis benefit of DES versus bare-metal stents (BMS), the incremental risk of stent thrombosis, a rare but serious complication of percutaneous coronary intervention (PCI), is not known with certainty.MethodsWe developed a decision analytic Markov model comparing DES versus BMS strategies for a contemporary PCI population. Procedure-related morbidity and mortality data from published reports were used to derive the model probabilities. Over a range of incremental risk and duration of risk of VLST, we identified the net benefit of DES versus BMS in terms of quality-adjusted life expectancy (QALE).ResultsUnder an assumption of equal stent thrombosis rates beyond 1 year, the DES strategy was superior to BMS in terms of QALE (16.262 vs. 16.248 quality-adjusted life years [QALYs], difference = 0.014). Under the alternative assumption of an incremental risk difference of 0.13%/year, the net benefit was substantially reduced (difference = 0.001 QALYs). The threshold excess risk of very late DES thrombosis compared with BMS, above which BMS would be the preferred strategy, was 0.14%/year (over 4 years of follow-up). This threshold increased as the population risk of restenosis increased and decreased as the vulnerable time window lengthened.ConclusionsA small absolute increase in DES thrombosis compared with BMS after 1 year (>0.14%/year) would result in BMS being the preferred strategy for the overall PCI population. Larger clinical trials with longer follow-up are needed to estimate the risk of late stent thrombosis with greater certainty for existing and new DES.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of the American College of Cardiology - Volume 51, Issue 19, 13 May 2008, Pages 1844–1853
نویسندگان
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