Restenotic outcomes and medical care costs following percutaneous transluminal coronary angioplasty with and without stent
Abstract
The purpose of the present study was to compare restenosis rates (repeat PTCA, coronary artery bypass grafting, or myocardial infarction) and medical care costs during one-year following stent PTCA and non-stent PTCA. Most studies on stents in PTCA have been limited to less than one-year of follow-up or to regional samples. A national claims database covering 1.7 million lives was used to identify 1,367 patients with PTCA during 1995 and no PTCA during the prior year. Stents were received by 304 of 1,367 patients. Chi-square analysis showed that there was no significant difference in the proportion of patients who experienced symptomatic restenosis (stent = 16.1% and non-stent = 20.1%, p = 0.12). Symptomatic restenosis was defined as occurrence of any of the following events: myocardial infarction (MI), repeat PTCA (stent or non-stent), or coronary artery bypass graft (CABG). There was no statistically significant difference between the stent PTCA and non-stent PTCA groups in proportions of patients experiencing MI, CABG, or repeat PTCA during the one-year follow-up period. Multivariate logit models were developed to evaluate the influence of stent use on probabilities of MI, CABG, repeat PTCA after controlling for gender, age, comorbidities and prior year hospital utilizations. After controlling for covariates, there was no statistically significant effect of stent use on probabilities of symptomatic restenosis, MI, CABG, or repeat PTCA during the one-year follow-up period. Although, there was no significant difference in mean one-year follow-up medical care costs, the mean total medical care costs including costs of initial PTCA was significantly higher for stent PTCA patients as compared non-stent PTCA patients. Multiple regressions after controlling for gender, age, comorbidities and prior year hospital utilizations further confirmed that there was no significant difference in one-year follow-up medical costs between stent PTCA and non-stent PTCA patients, although one-year total medical care costs including costs of initial PTCA was significantly higher for stent PTCA patients as compared to non-stent PTCA patients.
Degree
Ph.D.
Advisors
Thomas, Purdue University.
Subject Area
Pharmaceuticals
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