Contacts:
Sarah Goodwin
Kathi Ovnic
Holly Korschun

January 6, 1998

THE STATE OF STENTING: Emory Findings Suggest Costs Decline as Stent Use Soars; Also, Women are Greater Risk for Restenosis After Stenting

CORONARY STENTING USE DRAMATICALLY INCREASES AS COSTS PLUNGE

From 1990-97, use of coronary stenting at Emory University Hospitals "increased from a procedure performed rarely to more than 50 percent of cases," reported Emory researchers in November at the 71st Scientific Sessions of the American Heart Association.

"Outcome of stent cases improved dramatically, in part due to patient mix, in part to technical improvements," says first author William S. Weintraub, M.D., professor of Medicine (Cardiology) at the Emory University School of Medicine. "Costs of balloon angioplasty and stents both fell, but stenting much more dramatically, such that in 1997 stents cost an average of $1,318 more than PTCA (percutaneous balloon angioplasty)."

In 1993, for instance, only 2.8 percent of patients at Emory receiving catheter-based interventions for coronary artery disease underwent stenting; the average cost of stenting was $16,375 per procedure and required a 6.5-day hospital stay.

Within four years, 50.1 percent of appropriate patients at Emory received stenting at an average cost of $7,687 per procedure and spent 2.1 days in the hospital.

"Changes in stent use and outcome appear to still be continuing," Dr. Weintraub says.

Cost of balloon angioplasty at Emory declined from $8,248 in 1991 to $6,305 in 1997, and length of hospital stay declined from 2.4 days in 1991 to 1.7 days in 1997.

Study data were collected from 1,082 patients receiving coronary stenting and 14,060 patients undergoing balloon angioplasty.

RISK OF RESTENOSIS GREATER FOR WOMEN THAN MEN AFTER CORONARY STENTING

Women are significantly more likely than men to experience complications after receiving stents to "prop" open occluded coronary arteries, concluded authors of an Emory University study presented at the 71st Scientific Sessions of the American Heart Association in November.

Six months after undergoing coronary stenting, indicators of restenosis, or a renarrowing of coronary arteries, were noted in 27 percent of 410 women versus 20 percent of 1,046 men evaluated. Researchers included heart attack, bypass surgery, repeat angioplasty and death as indicators of "clinical" restenosis.

When researchers compared the group of coronary stenting patients with 7,735 men and 3,111 women who had undergone balloon angioplasty without stenting, they found that stenting was associated with poorer outcomes for both genders, though more so for women who received stents, 27 percent of whom experienced clinical restenosis versus 20 percent of the female patients who received angioplasty alone.

Data indicated that risk of death at the time of the initial procedure or six months later was greater for both groups of women (angioplasty patients either did or did not receive stents) compared with both groups of men. In the analysis, researchers took into account that women in the study were older and had more diabetes and high blood pressure than male subjects.

"With caution in the nonrandomized comparison of coronary stenting to balloon angioplasty, these data show that clinical restenosis is not eliminated by coronary stenting, revealing the need for brachytherapy or other new therapy to prevent restenosis, especially in woman," says first author William S. Weintraub, M.D., professor of Medicine (Cardiology) at the Emory University School of Medicine.

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