Clinical impact of drug-eluting stents in changing referral practices for coronary surgical revascularization in a tertiary care center

Alexandre C. Ferreira, Arley A. Peter, Tomas Salerno, Hooshang Bolooki, Eduardo De Marchena

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Abstract

Background. The long-term benefits of angioplasty are limited by the occurrence of restenosis. Drug-eluting stents with a projected restenosis rate of close to 0% are soon to become available. The short- and long-term consequences of this advance to the cardiac surgical volume remain unclear. Methods. A total of 196 consecutive coronary angiograms and medical records of patients referred for coronary bypass surgery were reviewed. Considering the hypothetical premise of having drug-eluting stents with a near zero restenosis rate, we reviewed each case to determine if surgical revascularization was still the preferred option for revascularization. Results. The mean age was 60 (±10.6) years. Seventy-two percent of patients were male. Considering the availability of drug-eluting stents 154 (79%) would still have been sent to surgery, representing a 21% decrease in the number of surgical revascularizations. Angiographic characteristics predicting coronary bypass revascularization were the presence of chronic total occlusion (odds ratio [OR]: 9.1; confidence interval [CI]: 2.1 to 39), left main coronary artery stenosis (OR: 9.6; CI: 1.27 to 73), and need for valvular surgery (OR: 7.38; CI: 1.3 to 157). The most common predictors of a change in clinical management from surgical to percutaneous revascularization if drug-eluting stents were available were diffuse coronary narrowing (OR: 15.78), restenotic lesions (OR: 27.86), and small coronary arteries (OR: 26). Conclusions. Drug-eluting stents may have a significant impact on cardiac surgery volume (approximately a 21% decrease in our center). It may also direct patients with small vessels, diffuse narrowing, or restenotic lesions and diabetic patients to percutaneous therapy.

Original languageEnglish
Pages (from-to)485-489
Number of pages5
JournalAnnals of Thoracic Surgery
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2003

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Drug-Eluting Stents
Tertiary Care Centers
Referral and Consultation
Odds Ratio
Cardiac Volume
Confidence Intervals
Coronary Stenosis
Angioplasty
Thoracic Surgery
Medical Records
Coronary Vessels
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Clinical impact of drug-eluting stents in changing referral practices for coronary surgical revascularization in a tertiary care center. / Ferreira, Alexandre C.; Peter, Arley A.; Salerno, Tomas; Bolooki, Hooshang; De Marchena, Eduardo.

In: Annals of Thoracic Surgery, Vol. 75, No. 2, 01.02.2003, p. 485-489.

Research output: Contribution to journalArticle

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abstract = "Background. The long-term benefits of angioplasty are limited by the occurrence of restenosis. Drug-eluting stents with a projected restenosis rate of close to 0{\%} are soon to become available. The short- and long-term consequences of this advance to the cardiac surgical volume remain unclear. Methods. A total of 196 consecutive coronary angiograms and medical records of patients referred for coronary bypass surgery were reviewed. Considering the hypothetical premise of having drug-eluting stents with a near zero restenosis rate, we reviewed each case to determine if surgical revascularization was still the preferred option for revascularization. Results. The mean age was 60 (±10.6) years. Seventy-two percent of patients were male. Considering the availability of drug-eluting stents 154 (79{\%}) would still have been sent to surgery, representing a 21{\%} decrease in the number of surgical revascularizations. Angiographic characteristics predicting coronary bypass revascularization were the presence of chronic total occlusion (odds ratio [OR]: 9.1; confidence interval [CI]: 2.1 to 39), left main coronary artery stenosis (OR: 9.6; CI: 1.27 to 73), and need for valvular surgery (OR: 7.38; CI: 1.3 to 157). The most common predictors of a change in clinical management from surgical to percutaneous revascularization if drug-eluting stents were available were diffuse coronary narrowing (OR: 15.78), restenotic lesions (OR: 27.86), and small coronary arteries (OR: 26). Conclusions. Drug-eluting stents may have a significant impact on cardiac surgery volume (approximately a 21{\%} decrease in our center). It may also direct patients with small vessels, diffuse narrowing, or restenotic lesions and diabetic patients to percutaneous therapy.",
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