Predictive factors for the second restenosis after coronary interventions

Cost-effectiveness of drug-eluting vs. bare-metal stents in patients with coronary artery disease from the Korean National Health Insurance Database

PURPOSE

The aim of this study was to evaluate the cost-effectiveness of the use of drug-eluting stents (DESs), as compared with bare-metal stents (BMSs) in Korea.

MATERIALS AND METHODS

A retrospective cohort study was conducted between January 2000 and December 2007. Subjects were stent-treated for the first time between 2004 and 2005, with four years of follow-up (2004-2007) (n=43674). The incremental cost-effectiveness ratio (ICER) was used to calculate the costs of DESs compared with BMSs among patients with coronary artery disease (CAD). Cost-effectiveness was assessed with effectiveness defined as a reduction in major adverse cardiac events after six months and after one, two, three, and four years.

RESULTS

The total costs of a DESs were 674108 Korean won (KRW) higher than that of a BMSs at the end of the follow-up; 13635 thousand KRW per patient treated with DESs and 12960 thousand KRW per patient treated with BMSs. The ICER was 256315 per KRW/death avoided and 293090 per KRW/re-stenting avoided among the CAD patients at the end of the follow-up.

CONCLUSION

The ICER for the high-risk patients was lower than that for the low-risk patients. The use of DESs is clinically more useful than the use of BMSs for CAD and myocardial infarction patients, especially for those considered to be high-risk patients in Korea.

An elevated value of C-reactive protein is the only predictive factor of restenosis after percutaneous coronary intervention

BACKGROUND

The current techniques for percutaneous coronary interventions (PCI) remain limited by restenosis. Recent studies have provided evidence of inflammation playing a role in the pathogenesis of cardiovascular disease.

METHODS

Whether inflammatory markers are predictors of subsequent restenosis were prospectively tested in 272 consecutive patients with angiographically proven coronary artery disease. Patients having undergone PCI at Chonnam National University Hospital, between Sept. 1999 and Mar. 2001, were divided into two groups according to the occurrence of restenosis on a follow-up coronary angiogram: Group I were patients with restenosis (n = 99, 59.5 +/- 10.8 years, M:F = 77:22) and Group II were those without restenosis (n = 173, 58.8 +/- 10.2 years, M:F = 131:42). The IgG seropositivity, cytomegalovirus (CMV) titers, C. pneumoniae. H. pylori and levels of C-reactive protein (CRP) were compared between the two groups.

RESULTS

There were no statistical differences in the seropositivity of the CMV IgG C. pneumoniae IgG and H. pylori IgG between the two groups (Groups I vs. II: 100 vs. 100%, 24.7 vs. 25.7% and 62.2 vs. 63.7%, respectively). Of the angiographic parameters, a low Thrombolysis in Myocardial Infarction (TIMI) flow (TIMI 0 or 1) was more common in Group I than Group II (p = 0.038). The patients with an elevated CRP (> 0.5 mg/dL) were more common in Group I than Group II (57.6 vs. 36.4%, p = 0.001), with the CRP values being higher in Group I than Group II (3.3 +/- 5.8 vs. 1.3 +/- 2.6 mg/dL, p = 0.001). According to a multiple logistic regression analysis, the CRP was the only predictor of restenosis, with an odds ratio of 2.1169 (95% C.I. 1.2062-3.7154, p = 0.009).

CONCLUSION

The CRP value is the most important predictor of restenosis after PCI.