A retrospective study of 6,671 patients comparing coronary stenting and balloon angioplasty

Objective. To determine whether coronary stenting, compared to percutaneous transluminal coronary angioplasty, reduces the incidence of five clinical endpoints during a six-month follow-up period. Background. There is considerable debate concerning whether coronary stents improve clinical outcomes, especially given the rapid growth in the use of coronary stents and their economic impact. Methods. Study population included a total of 6,671 consecutive patients at 32 hospitals in 16 different states who underwent single or multi-vessel r evascularization during 1997. Patients were divided into one of two groups: these who only underwent standard balloon angioplasty (PTCA) for all treat ed vessels and those who received coronary stents (STENT) in all treated ve ssels. Results. STENT patients were significantly less likely to have emergency co ronary artery bypass surgery (CABG) (p = 0.001) or die during initial proce dure (p = 0.034) but were more likely than PTCA patients to be treated for hematoma (p = 0.002) and bradycardia (p = 0.004). After accounting for diff erence in patient characteristics, risk factors, procedure complications, a nd number of devices utilized, the estimated odds-ratio indicates that coro nary stenting, compared to PTCA, significantly (p < 0.05) reduced adverse o utcomes for only one clinical event, myocardial infarction. Conclusions. Compared to balloon angioplasty patients, coronary stent patie nts have no statistically significant differences in regard to additional p ercutaneous coronary intervention or coronary artery bypass during a sis-mo nth follow-up period. Since direct cardiac catheterization lab costs associ ated with coronary stenting is nearly 2.5 times greater than standard ballo on angioplasty, our results suggest the cost-effectiveness of coronary sten ting, especially for "hard" clinical outcomes, needs to be established.