Drug-eluting stents in clinical routine: a 1-year follow-up analysis based on German health insurance administrative data from 2008 to 2014. Issue 7 (28th July 2017)

• Record Type: Journal Article
• Authors: Jeschke, Elke; Searle, Julia; Günster, Christian; Baberg, Henning Thomas; Dirschedl, Peter; Levenson, Benny; Malzahn, Jürgen; Mansky, Thomas; Möckel, Martin
• Is Part Of: BMJ open. Volume 7:Issue 7(2017)
• Publication Date: 2017-07-28
• Subjects: drug-eluting stents -- administrative data -- MACCE -- safety -- healthcare research -- bio-resorbable vascular scaffolds; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2017-017460
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To describe the use of drug-eluting stents (DESs) in the largest population of statutory health insurance members in Germany, including newly developed bio-resorbable vascular scaffolds (BVSs), and to evaluate 1-year complication rates of DES as compared with bare metal stents (BMSs) in this cohort. Design: Routine data analysis of statutory health insurance claims data from the years 2008 to 2014. Setting: The German healthcare insurance Allgemeine Ortskrankenkasse covers approximately 30% of the German population and is the largest nationwide provider of statutory healthcare insurance in Germany. Participants and interventions: We included all patients with a claims record for a percutaneous coronary intervention (PCI) with either DES or BMS and additionally, from 2013, BVS. Patients with acute myocardial infarction (AMI) were excluded. Main outcome measure: major adverse cerebrovascular and cardiovascular event (MACCE, defined as mortality, AMI, stroke and transient ischaemic attack), bypass surgery, PCI and coronary angiography) at 1 year after the intervention. Results: A total of 243 581 PCI cases were included (DES excluding BVS: 143 765; BVS: 1440; BMS: 98 376). The 1-year MACCE rate was 7.42% in the DES subgroup excluding BVS and 11.29% in the BMS subgroup. The adjusted OR for MACCE was 0.72 (95% CI 0.70 to 0.75) in patients with DES excluding BVS as compared with patients with BMS. In the BVS group, the proportion of 1-year MACCE was 5.0%. Conclusion: The analyses demonstrate a lower MACCE rate for PCI with DES. BVSs are used in clinical routine in selected cases and seem to provide a high degree of safety, but data are still sparse.