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Model Can Identify Patients Who Will Benefit Most from DES

Although it compared well to existing models, prospective testing is required

A predictive model using commonly collected variables can identify patients who are at highest risk for restenosis and would derive the most benefit from drug-eluting stents, according to a study published recently on the Circulation website.

Drug-eluting stents (DES) for percutaneous coronary intervention (PCI) decrease the risk of restenosis compared to bare metal stents (BMS), although they are more expensive and require long-term antiplatelet therapy to prevent stent thrombosis. To help physicians identify the patients at highest risk for target vessel revascularization (TVR), the authors developed and validated a model to predict TVR. Using pre-procedural clinical and angiographic data from 27,107 PCI hospitalizations between October 1, 2004 and September 30, 2007, the researchers developed prediction models for TVR at one year. Models were developed from a two-thirds random sample and validated in the remaining third.

The overall rate of TVR was 7.6 percent (6.7 percent with DES and 11.0 percent with BMS). Predictors of TVR included prior PCI, peripheral vascular disease, diabetes, and angiographic characteristics. The model was superior to a three-variable model of diabetes, stent diameter, and stent length. The predicted number needed to treat with DES to prevent one TVR compared with BMS ranged from six to 80.

The authors conclude that the "prospective use of individualized assessments of patient benefits may support the safer and more cost-effective application of this technology. Moreover, prospectively informing patients of the benefits of a DES may support shared medical decision making and improve patients' understanding of the need for long-term dual antiplatelet therapy within the context of their reduced risk for TVR after DES."

Source: Yeh RW, Normand SLT, Wolf RE, at al. 2011. Predicting the restenosis benefit of drug-eluting versus bare metal stents in percutaneous coronary intervention. Published on September 6, 2011 on the Circulation website.