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Effects of Coronary Stents on Cardiovascular Outcomes in Broad-Based Clinical Practice
Stephen E. Kimmel, MD, MSCE;
A. Russell Localio, JD, MPH, MS;
Colleen Brensinger, MS;
Carolyn Miles, MPH;
John Hirshfeld, MD;
Howard L. Haber, MD;
Brian L. Strom, MD, MPH
Arch Intern Med. 2000;160:2593-2599.
Background Although stents have been shown to reduce the need for repeated percutaneous coronary intervention (PCI) in randomized trials, the effects of stents in broad-based, diverse clinical practice have not been well studied, nor has their effect on subsequent myocardial infarction or cardiac death.
Methods A retrospective cohort study was performed that included all 43 hospitals performing PCI in Pennsylvania in the last quarter of 1995, with the use of the Pennsylvania Health Care Cost Containment Council database. All 5258 patients who underwent PCI, excluding those with previous PCI within the preceding 6 months, were included. The primary outcomes were in-hospital events (death or coronary bypass), 6-month revascularization rates, and 6-month rates of cardiac death or myocardial infarction.
Results A total of 1240 patients (24%) had a stent procedure. Compared with nonstent procedures, stents reduced the risk of in-hospital events (multivariable odds ratio adjusted for patient and hospital level differences, 0.63; 95% confidence interval, 0.41-0.97), primarily because of a 52% reduction in the need for coronary bypass. Stents also reduced the need for follow-up revascularization procedures (multivariable hazard ratio, 0.72; 95% confidence interval, 0.59-0.87), primarily because of a 31% reduction in repeated PCI. However, stents had no effect on 6-month rate of myocardial infarction or cardiac death (multivariable hazard ratio, 0.97; 95% confidence interval, 0.71-1.33).
Conclusions Using stents decreases the need for repeated PCI in broad-based clinical practice, confirming results from randomized trials. However, this study did not detect any effect on subsequent myocardial infarction or cardiac death.
From the Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine (Drs Kimmel, Localio, and Strom and Mss Brensinger and Miles), Cardiovascular Division (Drs Kimmel and Hirshfeld) and Division of General Internal Medicine (Dr Strom), Department of Medicine, Hospital of the University of Pennsylvania, and Cardiovascular Division, Department of Medicine, Pennsylvania Hospital (Dr Haber), Philadelphia.
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