부산대학교 도서관

Aims The British National Institute of Clinical Excellence ( NICE) guidelines recommend to use drug-eluting stents ( DES) instead of bare-metal stents ( BMS) only in lesions >15 mm in length or in vessels <3 mm in diameter. We analyzed the impact of stent length and stent diameter on in-stent restenosis ( ISR) in the BASKET- PROVE study population and evaluated the cost-effectiveness of DES compared to BMS. Methods/Results The BASKET- PROVE trial compared DES vs BMS in large coronary arteries (≥3 mm). We calculated incremental cost-effectiveness ratios ( ICERs) and cost-effectiveness acceptability curves with regard to quality-adjusted life years ( QALYs) gained and target lesion revascularizations ( TLRs) avoided. A total of 2278 patients were included in the analysis. A total of 74 ISR in 63 patients were observed. In-stent restenosis was significantly more frequent in segments treated with a BMS compared to segments treated with a DES (5.4% vs 0.76%; P<.001). The benefit of a DES compared to a BMS regarding ISR was consistent among the subgroups of stent length >15 mm and ≤15 mm, respectively. With the use of DES in short lesions, there was only a minimal gain of 0.005 in QALYs. At a threshold of 10 000 CHF per TLR avoided, DES had a high probability of being cost-effective. Conclusion In the BASKET- PROVE study population, the strongest predictor of ISR is the use of a BMS, even in patients in need of stents ≥3.0 mm and ≤15 mm lesion length and DES were cost-effective. This should prompt the NICE to reevaluate its recommendation to use DES instead of BMS only in vessels <3.0 mm and lesions >15 mm length. [ABSTRACT FROM AUTHOR]