Treatment variation in stent choice in patients with stable or unstable coronary artery disease |
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| Authors: | L. T. Burgers E. A. McClellan I. E. Hoefer G. Pasterkamp J. W. Jukema S. Horsman N. H. J. Pijls J. Waltenberger M. A. Hillaert A. C. Stubbs J. L. Severens W. K. Redekop |
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| Affiliation: | 1.Institute of Health Policy & Management, and Institute for Medical Technology Assessment,Erasmus University Rotterdam,Rotterdam,The Netherlands;2.Department of Mathematical and Computer Sciences,Metropolitan State University of Denver,Colorado,USA;3.Laboratory of Experimental Cardiology,UMC Utrecht,Utrecht,The Netherlands;4.Department of Cardiology,Leiden UMC,Leiden,The Netherlands;5.Department of Bioinformatics,Erasmus Medical Center,Rotterdam,The Netherlands;6.Department of Cardiology,Catharina Hospital Eindhoven,Eindhoven,The Netherlands;7.Department of Cardiology,Maastricht University Medical Center,Maastricht,The Netherlands;8.Department of Cardiovascular Medicine,University of Münster,Münster,Germany;9.Department of Cardiology,University Medical Centre Utrecht,Utrecht,The Netherlands |
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| Abstract: | AimVariations in treatment are the result of differences in demographic and clinical factors (e.g. anatomy), but physician and hospital factors may also contribute to treatment variation. The choice of treatment is considered important since it could lead to differences in long-term outcomes. This study explores the associations with stent choice: i.e. drug-eluting stent (DES) versus bare-metal stents (BMS) for Dutch patients diagnosed with stable or unstable coronary artery disease (CAD).Methods & resultsAssociations with treatment decisions were based on a prospective cohort of 692 patients with stable or unstable CAD. Of those patients, 442 patients were treated with BMS or DES. Multiple logistic regression analyses were performed to identify variables associated with stent choice. Bivariate analyses showed that NYHA class, number of diseased vessels, previous percutaneous coronary intervention, smoking, diabetes, and the treating hospital were associated with stent type. After correcting for other associations the treating hospital remained significantly associated with stent type in the stable CAD population.ConclusionsThis study showed that several factors were associated with stent choice. While patients generally appear to receive the most optimal stent given their clinical characteristics, stent choice seems partially determined by the treating hospital, which may lead to differences in long-term outcomes. |
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