Although interventional cardiology can involve a wide variety of procedures and technologies, we are focusing on coronary stents, one of the largest categories of supply spend in hospitals. Although the use of balloon angioplasty was intitially pioneered in the 1960s and 1970s, stenting of the coronary vessels didn’t catch on as a standard treatment until the last 20 years.
The changes in stenting technology that have evolved over the last couple of decades and have included improved delivery systems, the use of drug-eluting stents to decrease the risk of blood clots, resorbable stents, and longer stents. While stenting was initially somewhat rare, the majority of percutaneous coronary interventions (PCI) receive at least one stent. Data from iDataResearch of British Columbia indicates that the average number of stents deployed for each PCI procedure was 1.29 in 2018, unchanged from 2017. They estimate the number of PCI procedures at just shy of 1,000,000 across all care settings, including ambulatory surgery centers, hospital outpatient departments, and hospital inpatients, although the vast majority of these procedures are affiliated with hospitals.
The percentage of patients undergoing a PCI procedure who received a stent has been quite high, with 84% receiving a stent in FY 2011 compared to 94% in FY 2017. This is based on calculating the number of PCI-stent related procedures to PCI-procedures.
Although there have been fairly dramatic shifts in the use of drug-eluting stents vs. bare metal or non-drug-eluting stents, the demographics of the patients receiving these devices have been relatively unchanged. According to data from AHRQ, the age distribution has been roughly 50% Medicare and 50% non-Medicare, and the percentage of male patients has remained at about 68% between 2014 and 2015, the most recent data available from AHRQ.
There have been a number of studies questioning the efficacy of stent procedures within the last ten years. Efficacy for stenting procedures is measured in a variety of ways, including incidence of thrombosis, survivorship, restenosis, among other events. There was an initial euphoria of stenting patients during angioplasty procedures, and technological innovations provided drug-eluting stents (DES), to reduce thrombosis, and then bioresorbable stents. However, according to data from AHRQ, the number of inpatient stenting procedures has declined since 2005. This reflects both the relative stability in procedures as well as the shift to outpatient procedures.
Download the whole publication here: Curvo Spotlight – Coronary Stents Vol 2 No 1
Editor – Stan Mendenhall
Associate Editor – Jake Titzer
Cartoons – Robin Wilt
Annie Gallup – Illustration and Graphic Design
Volume 1, Number 2
February 2019 Publication