Long-term efficacy and safety of drug-coated balloons versus drug-eluting stents for small coronary artery disease (BASKET-SMALL 2): 3-year follow-up of a randomised, non-inferiority trial

The Lancet ◽  
2020 ◽  
Vol 396 (10261) ◽  
pp. 1504-1510 ◽  
Author(s):  
Raban V Jeger ◽  
Ahmed Farah ◽  
Marc-Alexander Ohlow ◽  
Norman Mangner ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Drug Eluting Stents ◽  
Efficacy And Safety ◽  
Term Efficacy ◽  
Drug Eluting ◽  
Artery Disease

Cost-effectiveness

ESC CardioMed ◽  
2018 ◽  
pp. 1395-1399
Author(s):  
Ruben L. J. Osnabrugge ◽  
A. Pieter Kappetein
Keyword(s):  
Coronary Artery Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Drug Eluting Stents ◽  
Long Term Follow Up ◽  
Drug Eluting ◽  
Artery Disease ◽  
The Cost

Approximately 2% of the total healthcare expenditure in the European Union is spent on coronary artery disease and these expenditures are expected to increase. In order to make rational decisions on resource allocation, clinical and economic outcomes of treatment strategies need to be analysed together. Cost-effectiveness studies provide a framework for making such decisions. The early economic studies comparing balloon angioplasty with coronary artery bypass grafting (CABG) show that the early cost benefit of angioplasty is lost at long-term follow-up. CABG provides a clinically and economically attractive treatment option in patients with severe coronary artery disease. Later studies with bare-metal or drug eluting stents showed that the higher invasiveness of CABG leads to a longer hospital stay and higher upfront costs. However, at longer follow-up the cost difference is small and clinical outcomes with CABG are better than with percutaneous coronary intervention (PCI). This makes CABG superior to PCI at long-term follow-up, both clinically and economically in patients with extensive coronary disease. Nevertheless, in patients with less complex coronary artery disease, PCI with drug-eluting stents may be preferred on both clinical and economic grounds. Although reduction in stent price does not have a big impact, several other developments may impact future economic comparisons between PCI and CABG. Newer-generation stents will enhance the clinical and economic profile of PCI. Moreover, better clinical decision-making tools and fractional flow reserve will impact the cost-effectiveness equation.

VERY LONG-TERM FOLLOW-UP OF DIABETIC PATIENTS WITH CORONARY ARTERY DISEASE UNDERGOING ANGIOPLASTY WITH CONVENTIONAL AND DRUG-ELUTING STENTS

2019 ◽  
Vol 73 (9) ◽  
pp. 137
Author(s):  
Mauricio Mocha ◽  
Matheus Oliveira Laterza Ribeiro ◽  
Guilherme Fernandes Carvalho ◽  
Jaime Linhares Filho ◽  
Eduardo Lima ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Drug Eluting Stents ◽  
Diabetic Patients ◽  
Long Term Follow Up ◽  
Drug Eluting ◽  
Artery Disease

scholarly journals Six-month clinical outcomes of drug eluting stents in patients with coronary artery disease: an experience in real-world Indian patients

2021 ◽  
Vol 9 (12) ◽  
pp. 3590
Author(s):  
Gaurav Sardarilal Verma
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Real World ◽  
Clinical Performance ◽  
Drug Eluting Stents ◽  
Angiographic Restenosis ◽  
Indian Patients ◽  
Drug Eluting ◽  
Artery Disease

Background: Treatment of patients with coronary artery disease using drug eluting stents (DES) remains a challenge due to stent thrombosis and in-stent restenosis. The present study sought to investigate the safety and clinical performance of DES in real-world Indian patients with coronary artery disease.Methods: This prospective, non-randomized, single-center study enrolled 114 patients with coronary artery disease who were implanted with DES from January-2005 to September-2007. Clinical and angiographic follow-up were performed at 6 months after the index procedure. The primary endpoints of the study were: (major adverse cardiac events (MACE) defined as a composite of any episode of rest angina, myocardial infarctions (MI), repeat percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), or (angiographic restenosis defined as ≥50% diameter stenosis at the treated site at 6-month follow-up. The secondary endpoints of the study were occurrence of any MACE events and stent vessel occlusion during the first 30 postprocedural days.Results: A total of 125 lesions were treated by implantation of 130 DES. Only one patient (0.9%) developed minor bleeding during hospitalization. At the 6-month follow-up, MACE was 10%, including 1 (1.3%) MI, 2 (2.5%) unstable angina, 3 (3.8%) stable angina, 1 (1.3%) repeat PCI, and 1 (1.3%) CABG. Angiographic restenosis was found in 7 (8.8%) patients. Comparison of characteristics between patients with and without angiographic restenosis revealed significant effects of presence of diabetes (p<0.012), hyperlipidaemia (p<0.028), and stent length>20 mm (p<0.05).Conclusions: The study results demonstrated excellent safety and clinical performance of DES in real-world Indian patients with coronary artery disease.

Comparison of Minimally Invasive Direct Coronary Artery Bypass Surgery with Implantation of Drug-Eluting Stents in Patients with Left Anterior Descending Coronary Artery Disease

2009 ◽  
Vol 4 (6) ◽  
pp. 340-344 ◽  
Author(s):  
Pierre Yves Etienne ◽  
David Glineur ◽  
Spiridon Papadatos ◽  
Gregory Kalscheuer ◽  
Yves Mairy ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Drug Eluting Stents ◽  
Percutaneous Coronary Interventions ◽  
Percutaneous Coronary ◽  
Drug Eluting ◽  
Artery Disease

Objective Bypass surgery and percutaneous coronary interventions improve the clinical status of patients with left anterior descending coronary artery disease. However, these techniques differ in invasiveness and in the need for subsequent reinterventions. The development of minimally invasive direct coronary artery bypass (MIDCAB) surgery and of drug-eluting stents (DES) offers perspectives to close this gap. Methods We compared the long-term clinical outcome of 308 patients after revascularization for isolated left anterior descending coronary artery disease. One hundred fifty-four patients were treated with MIDCAB and 154 with percutaneous coronary interventions and DES implantation. Results Both groups were similar in age (63 ± 13 and 62 ± 10 years), Euroscore (3.3 ± 2.8 and 3.4 ± 2.6), and mean duration of follow-up (30 ± 17 and 24 ± 10 months). Two-year survival was similar after MIDCAB and after DES (97.4% and 94.8%). During follow-up, four patients (2.6%) of the MIDCAB group and 21 patients (13.6%) of the DES group needed subsequent revascularization of the target vessel (P = 0.001). Revascularization of a nontarget vessel was needed in 11 patients (7%) of the MIDCAB group and in 17 patients (11%) of the DES group (NS). Neurologic complications included two transient ischemic accidents and two strokes in the MIDCAB group but three fatal cerebral hemorrhages and one stroke in the DES group. Major adverse coronary and cerebrovascular events rates were 14% in the MIDCAB and 31% in the DES group. Conclusions MIDCAB and DES implantation showed similar rates of mortality but a higher reintervention rate after DES. Anticoagulation implications remain critical for the future of DES.

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