Harvard Heart Letter

Drug-eluting stents being misused

A new study performed at Harvard-affiliated Massachusetts General Hospital and other locations found that the choice to use drug-eluting stents after angioplasty was not always based on the risk of reblockage of the treated artery (or restenosis), the situation the devices were designed to prevent. A review of 1.5 million people in the largest U.S. clinical registry of stent procedures found that only 13% were considered at high risk of restenosis, yet 77% received drug-eluting stents. Although drug-eluting stents were correctly used in 83% of those at high risk, they were also implanted in 74% of those at low risk. It would be necessary to treat 25 to 130 people in this group with drug-eluting stents, rather than less-expensive bare-metal stents, in order to prevent a single repeat revascularization. The researchers calculated that reducing the use of drug-eluting stents by 50% in people who don't need them would save $200 million a year in the cost of the stents plus the medications that must be taken afterwards. In this study, the risk of restenosis was calculated using several variables, including diameter of the artery, length of the blockage, and presence of diabetes.

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