Current trends in use of drug-eluting-stents (DES) and non-DES in coronary vessel revascularization in the US.

Zoltowska, Dominika

Background
In the current era of drug-eluting stents (DES), non-DES are still a feasible option for patients with contraindication or suspected noncompliance to prolong dual antiplatelet therapy.This study was performed to recognize demographic features and analyze the current trends in use of DES and non-DES in coronary vessel revascularization in the US between 2010-2014 utilizing the NIS database.

Methods
Nationwide Inpatient Sample (NIS) data was used to extract data of patients undergoing DES and non-DES implantation to coronary vessels during index admission for years 2010-2014. Patients were identified by ICD-9 procedure code 36.07 and 36.06 representing respectively insertion of DES and non- DES to coronary vessels. Demographic features and trends were analyzed.

Results
A total of 1 846 796 procedures of DES and 568 572 of non-DES insertion were recognized between 2010 and 2014. Accordingly to this, the number of procedures with the use of DES was 3.25 fold higher. In both cohorts men predominated and accounted for almost 70% of all patients.There was a constant downtrend in the use of non-DES. Whereas a downward trend in the use of DES started in 2010. The number of DES has dropped 1.85-fold between 2010 and 2014. Patients undergoing DES implantation were more commonly in age group of 45-64 (45.5%), whereas most patients receiving non-DES were aged between 65-84 year (43%). The main insurance for both procedures was Medicare (51% and 52.8% respectively). Majority of both procedure was performed in urban hospitals (60%,69%), predominantly in large (68.3%, 68%), teaching institutions (57%,55%). Geographically, both procedures were most commonly performed in southern part of the US (38.4%, 41%).

Conclusions
Our most recent data was showing downtrend in both DES and non-DES implantation. It possibly reflects more cautious patient selection for coronary intervention. Non-DESs seem to be a possible alternative to DESs especially for patients in more advanced age.