THE IMPACT OF OPTIMAL STENTING TECHNIQUES ON CARDIAC-CATHETERIZATION LABORATORY RESOURCE UTILIZATION AND COSTS

Coronary stenting has been shown to reduce angiographic restenosis and improve clinical outcomes compared with conventional balloon angiopla sty, but at greater in-lab cost. Recent studies have suggested that '' optimal'' stent deployment can eliminate the need for intensive oral a nticoagulation after stenting, with the potential to reduce vascular c omplications, length of stay, and hospital cost. Between January and J une 1995, we performed elective 1-vessel coronary stenting in 78 patie nts with a single, discrete (<15 mm) coronary stenosis (optimal single -lesion group) and in 30 patients with either a single, long stenosis or serial discrete lesions (optimal multilesion group). Compared with stent patients from the Stent Restenosis Study (STRESS) economic sub-s tudy, optimal single-lesion stenting required more stents (1.3 +/- 0.6 vs 1.1 +/- 0.4, p < 0.01) and more adjunctive angioplasty balloons pe r patient (2.5 +/- 1.0 vs 2.0 +/- 0.9, p < 0.01). As a result, cathete rization laboratory costs for single-lesion stenting increased by near ly $600 between 1993 and 1995 ($4,619 +/- $1,120 [median $4,435] to $5 ,209 +/- $1,697 [median $4,673], p < 0.01). Compared with the STRESS a ngioplasty group, optimal coronary stenting increased catheterization laboratory costs by nearly $2,200 ($3,012 +/- $1,382 [median $2,548] v s $5,209 +/- $1,697 [median $4,673], p < 0.01). Optimal stenting of lo ng lesions or multiple discrete stenoses increased catheterization lab oratory costs by an additional $2,000 compared with optimal single-les ion stenting ($7,201 +/- $2,428 [median $6,887] vs $5,209 +/- $1,697 [ median $4,673], p < 0.01). These findings demonstrate that optimal cor onary stenting increases in-lab procedural resource utilization and co sts compared with historical stenting techniques. Based on the downstr eam cost savings seen in the STRESS trial ($1,400/patient), it is unli kely that current optimal stenting techniques will result in an overal l cost savings compared with balloon angioplasty. (C) 1997 by Excerpta Medica, Inc.