The aim of this study was to compare 5-year cost-effectiveness and clinical outcomes
of patients with oral rapamycin (OR) plus bare-metal stent versus the drug-eluting
stent (DES) strategy. During 2006 to 2007, a total of 200 patients were randomized
to OR (n = 100) and DES (n = 100). Primary end point was to compare costs of initial
procedure and cost-effectiveness of both revascularization strategies. Safety was
evaluated by the composite of death, myocardial infarction, and cerebrovascular accident.
Efficacy was assessed by target vessel and target lesion revascularizations. The 2
groups had similar baseline demographic, clinical, and angiographic characteristics.
In the DES group, paclitaxel-, zotarolimus-, and sirolimus-eluting stents were used.
Five-year clinical follow-up was accomplished in 99% patients. The DES group had significantly
higher procedural (p <0.001), discharge to first-year (p = 0.02), and 1- to 5-year
costs (p <0.001) compared with the OR group. At 5 years, the composite end point of
death, myocardial infarction, and cerebrovascular accident (12% in the OR group vs
25% in the DES group, p = 0.01) was significantly less in the OR group. Target vessel
revascularization (14.5% in the OR group vs 21% in the DES group, p = 0.16) and target
lesion revascularization (10% in the OR group vs 17.6% in the DES group, p = 0.05)
were not significantly different. In conclusion, a strategy of OR plus bare-metal
stent was cost saving than a first-generation DES.
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Article info
Publication history
Published online: December 16, 2013
Accepted:
November 14,
2013
Received in revised form:
November 14,
2013
Received:
September 17,
2013
Footnotes
A complete list of investigators is available in the Supplementary Data.
See page 820 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
