May 25, 2008 The more than ten million Americans who've received drug-eluting stents to open their blocked coronary arteries have a bright future, according to new research from the University of Pennsylvania School of Medicine. Patients with drug-coated stents are less apt to die, have heart attacks or require extra stents or bypass surgery in the two years following placement of the stent, compared to those who receive bare metal stents, according to University of Pennsylvania School of Medicine research that will be published in the May 27 issue of the Journal of the American College of Cardiology.
The findings, among the first large follow-up studies to show a clear, lifesaving benefit of drug-eluting stents compared to bare metal stents, will be published in the May 27 issue of the Journal of the American College of Cardiology. Patients with the drug-coated stents -- designed not only to open blocked coronary arteries but also to chemically inhibit future blockage -- were less apt to die, have heart attacks or require extra stents or bypass surgery in the two years following placement of the stent.
"This might be a hidden nugget of goodness that could not be detected in clinical trials," says Peter W. Groeneveld, MD, MS, assistant professor in Penn's Division of General Internal Medicine. "There is a distinct possibility that drug-eluting stents not only reduce the need for future cardiac procedures, but also save lives."
Groeneveld and his colleagues studied Medicare data to identify about 72,000 patients who received drug-eluting stents during a nine-month period in 2003, the first year the devices were approved for use in the United States. Overall, the findings showed a clear survival benefit compared to a control group of patients who got bare metal stents -- at 90 days, 1 year and 2 years, patients with drug-coated stents were less likely to die.
In a separate study which will be published in the June issue of the American Heart Journal, Groeneveld also found that drug-eluting stents also offer cost savings during the first year after placement. Although the initial cost of the device -- averaging $16,000 -- outpaces that of a bare metal stent, which costs about $14,000, the Penn researchers found that among patients with the drug-coated stents, 12 percent of those studied needed additional stents placed in the first year, compared to 15 percent of patients who received bare-metal stents.
Few patients in either arm required bypass surgery in the first year following stent placement, but those who received bare-metal stents were twice as likely to need the procedure, leading to an additional cost savings of $714 per patient treated with drug-coated stents. Overall, researchers found that patients with drug-eluting stents each saved an average of $1,350 worth of follow-up care during the year, which projects a total savings of approximately $100 million dollars among the 72,000 drug-eluting stent patients studied.
The researchers note that future studies should focus on how drug therapies including clopidogrel and cholesterol-reducing statin drugs may play a role in outcomes and costs for both types of stent patients. Since recent evidence shows that clopidogrel therapy -- aimed at reducing the risk of blood clots following stent placement -- is an essential step for reducing "late" drug-eluting stent complications or failure, Groeneveld theorizes that clinical outcomes for drug-eluting stent patients might be boosted even further when patients follow an appropriate long-term drug regimen.
This work was supported by an unrestricted grant from the Institute for Health Technology Studies (InHealth), a 501(c)3 foundation based in Washington, DC.
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