Advertisement

Utilization of Non–Drug-Eluting Devices for Inpatient Percutaneous Coronary Intervention in the United States

Published:November 01, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.09.033
      There is a paucity of data on the contemporary use of non–drug-eluting devices (balloon angioplasty or bare-metal stents) in contemporary percutaneous coronary intervention (PCI) in the United States. We utilized the Nationwide Readmissions Database to identify patients hospitalized to undergo PCI with non–drug-eluting devices from 2016 to 2019. The main outcome of interest was the trends in utilization over the study years. Among 1,870,262 PCI procedures, 127,810 (6.8%) were performed with non–drug-eluting devices; 72% of these were in the setting of acute myocardial infarction (MI). The use of non–drug-eluting devices decreased throughout the study period from 12.9% of all PCI in the first quarter of 2016 to 3.4% in the last quarter of 2019 (p <0.001). Factors associated with their use included advanced age and high bleeding risk. Only a small percentage were used as a bridge to coronary artery bypass graft surgery (2%) and for treatment of in-stent restenosis (3%). The in-hospital mortality was 5.8% for the entire cohort and 6.6% when the indication for use was an acute MI. In patients presenting with an acute MI, reinfarction within 30 days was common and occurred in 18% of the patients. In conclusion, the use of non–drug-eluting devices in PCI in the United States decreased from 2016 to 2019. Factors associated with their use included old age and high bleeding risk. Due to suboptimal outcomes in patients currently being treated with non–drug-eluting devices, there remains an unmet clinical need for alternative treatment options.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Piccolo R
        • Bonaa KH
        • Efthimiou O
        • Varenne O
        • Baldo A
        • Urban P
        • Kaiser C
        • Remkes W
        • Raeber L
        • de Belder A
        • van't Hof AW.
        Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials.
        Lancet. 2019; 393: 2503-2510
        • Chichareon P
        • Modolo R
        • Collet C
        • Tenekecioglu E
        • Vink MA
        • Oh PC
        • Ahn JM
        • Musto C
        • Díaz de la Llera LS
        • Cho YS
        • Violini R
        Efficacy and safety of stents in ST-segment elevation myocardial infarction.
        J Am Coll Cardiol. 2019; 74: 2572-2584
        • Krucoff MW
        • Urban P
        • Tanguay JF
        • McAndrew T
        • Zhang Y
        • Rao SV
        • Morice MC
        • Price MJ
        • Cohen DJ
        • Abdel-Wahab M
        • Mehta SR
        • Faurie B
        • McLaurin B
        • Diaz C
        • Stoll HP
        • Pocock S
        • Leon MB
        Global approach to high bleeding risk patients with polymer-free drug-coated coronary stents: The LF II Study.
        Circ Cardiovasc Interv. 2020; 13e008603
        • Valgimigli M
        • Cao D
        • Angiolillo DJ
        • Bangalore S
        • Bhatt DL
        • Ge J
        • Hermiller J
        • Makkar RR
        • Neumann FJ
        • Saito S
        • Picon H
        • Toelg R
        • Maksoud A
        • Chehab BM
        • Choi JW
        • Campo G
        • De la Torre Hernandez JM
        • Kunadian V
        • Sardella G
        • Thiele H
        • Varenne O
        • Vranckx P
        • Windecker S
        • Zhou Y
        • Krucoff MW
        • Ruster K
        • Zheng Y
        • Mehran R
        XIENCE 90 and XIENCE 28 Investigators. Duration of dual antiplatelet therapy for patients at high bleeding risk undergoing PCI.
        J Am Coll Cardiol. 2021; 78: 2060-2072
        • Escaned J
        • Cao D
        • Baber U
        • Nicolas J
        • Sartori S
        • Zhang Z
        • Dangas G
        • Angiolillo DJ
        • Briguori C
        • Cohen DJ
        • Collier T
        • Dudek D
        • Gibson M
        • Gil R
        • Huber K
        • Kaul U
        • Kornowski R
        • Krucoff MW
        • Kunadian V
        • Mehta S
        • Moliterno DJ
        • Ohman EM
        • Oldroyd KG
        • Sardella G
        • Sharma SK
        • Shlofmitz R
        • Weisz G
        • Witzenbichler B
        • Pocock S
        • Mehran R.
        Ticagrelor monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention: TWILIGHT-HBR.
        Eur Heart J. 2021; 42: 4624-4634
        • Wańha W
        • Bil J
        • Januszek R
        • Gilis-Malinowska N
        • Figatowski T
        • Milewski M
        • Pawlik A
        • Staszczak B
        • Wybraniec M
        • Tomasiewicz B
        • Kübler P
        • Kuliczkowski W
        • Walczak T
        • Hrymniak B
        • Desperak P
        • Mielczarek M
        • Ciecwierz D
        • Niezgoda P
        • Wolny R
        • Chudzik M
        • Ł Kuźma
        • Kralisz P
        • Kedhi E
        • D'Ascenzo F
        • Hudziak D
        • Kowalówka A
        • Smolka G
        • Reczuch K
        • Gruchała M
        • Kubica J
        • Gil RJ
        • Dobrzycki S
        • Dudek D
        • Bartuś S
        • Gąsior M
        • Ochała A
        • Witkowski A
        • Jaguszewski M
        • Wojakowski W
        Long-term outcomes following drug-eluting balloons versus thin-strut drug-eluting stents for treatment of in-stent restenosis (DEB-dragon-registry).
        Circ Cardiovasc Interv. 2021; 14e010868
        • Megaly M
        • Rofael M
        • Saad M
        • Shishehbor M
        • Brilakis ES.
        Outcomes With drug-coated balloons for treating the side branch of coronary bifurcation lesions.
        J Invasive Cardiol. 2018; 30: 393-399
        • Morice M-C
        • Urban P
        • Greene S
        • Schuler G
        • Chevalier B.
        Why are we still using coronary bare-metal stents?.
        J Am Coll Cardiol. 2013; 61: 1122-1123
      1. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. HCUP Nationwide Readmissions Database (NRD). Available at: http://www.hcup-us.ahrq.gov/nrdoverview.jsp. Accessed on May 21, 2022.

        • Khera R
        • Angraal S
        • Couch T
        • Welsh JW
        • Nallamothu BK
        • Girotra S
        • Chan PS
        • Krumholz HM.
        Adherence to methodological standards in research using the national inpatient sample.
        JAMA. 2017; 318: 2011-2018
      2. Houchens RL, Elixhauser A. Using the HCUP Nationwide Inpatient Sample to estimate trends (updated for 1988–2004). Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Available at: https://www.hcup-us.ahrq.gov/reports/methods/2006_05_NISTrendsReport_1988-2004A.pdf. Accessed on May 21, 2022.

        • Pasceri V
        • Patti G
        • Speciale G
        • Pristipino C
        • Richichi G
        • Di Sciascio G
        Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction.
        Am Heart J. 2007; 153: 749-754
        • Boyden TF
        • Nallamothu BK
        • Moscucci M
        • Chan PS
        • Grossman PM
        • Tsai TT
        • Chetcuti SJ
        • Bates ER
        • Gurm HS.
        Meta-analysis of randomized trials of drug-eluting stents versus bare metal stents in patients with diabetes mellitus.
        Am J Cardiol. 2007; 99: 1399-1402
        • Piccolo R
        • Bonaa KH
        • Efthimiou O
        • Varenne O
        • Urban P
        • Kaiser C
        • Räber L
        • de Belder A
        • Remkes W
        • Van't Hof AWJ
        • Stankovic G
        • Lemos PA
        • Wilsgaard T
        • Reifart J
        • Rodriguez AE
        • Ribeiro EE
        • Serruys PWJC
        • Abizaid A
        • Sabaté M
        • Byrne RA
        • de la Torre Hernandez JM
        • Wijns W
        • Esposito G
        • Jüni P
        • Windecker S
        • Valgimigli M
        Coronary Stent Trialists’ (CST) Collaboration. Drug-eluting or bare-metal stents for left anterior descending or left main coronary artery revascularization.
        J Am Heart Assoc. 2021; 10e018828
        • Aggarwal V
        • Stanislawski MA
        • Maddox TM
        • Nallamothu BK
        • Grunwald G
        • Adams JC
        • Ho PM
        • Rao SV
        • Casserly IP
        • Rumsfeld JS
        • Brilakis ES.
        Safety and Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions.
        J Am Coll Cardiol. 2014; 64: 1825-1836
        • Neumann FJ
        • Sousa-Uva M
        • Ahlsson A
        • Alfonso F
        • Banning AP
        • Benedetto U
        • Byrne RA
        • Collet JP
        • Falk V
        • Head SJ
        • Jüni P
        • Kastrati A
        • Koller A
        • Kristensen SD
        • Niebauer J
        • Richter DJ
        • Seferovic PM
        • Sibbing D
        • Stefanini GG
        • Windecker S
        • Yadav R
        • Zembala MO
        ESC Scientific Document Group2018 ESC/EACTS guidelines on myocardial revascularization.
        Eur Heart J. 2019; 40: 87-165
        • Lawton JS
        • Tamis-Holland JE
        • Bangalore S
        • Bates ER
        • Beckie TM
        • Bischoff JM
        • Bittl JA
        • Cohen MG
        • DiMaio JM.
        ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2022; 79: e21-e129
        • Rymer JA
        • Harrison RW
        • Dai D
        • Roe MT
        • Messenger JC
        • Anderson HV
        • Peterson ED
        • Wang TY.
        Trends in bare-metal stent use in the United States in patients aged ≥ 65 years (from the CathPCI Registry).
        Am J Cardiol. 2016; 118: 959-966
        • Giannini F
        • Pagnesi M
        • Campo G
        • Donahue M
        • Ferri LA
        • Briguori C
        • Stefanini GG
        • Scardala R
        • Sardella G
        • De Rosa S
        • Figini F
        • Monello A
        • Pastormerlo LE
        • Testa L
        • Nicolino A
        • Ielasi A
        • Durante A
        • Leone A
        • Tzanis G
        • Mangieri A
        • Ciccarelli G
        • Briani M
        • Reimers B
        • Ceccacci A
        • Indolfi C
        • Sheiban I
        • Palmieri C
        • Bedogni F
        • Tespili M
        • Latib A
        • Gallo F
        • Colombo A
        Italian Multicenter Registry of Bare Metal Stent Use in Modern Percutaneous Coronary Intervention Era (AMARCORD): a multicenter observational study.
        Catheter Cardiovasc Interv. 2021; 97: 411-420
        • Ipek G
        • Keskin M
        • Aldag M
        • Borklu EB
        • Inan D
        • Yilmaz H
        • Demirtas M
        • Bolca O.
        Balloon angioplasty versus stenting in patients with ST-elevated myocardial infarction Before subsequent coronary artery by-pass grafting.
        Angiology. 2021; 72: 836-841
        • Scheller B
        • Hennen B
        • Severin-Kneib S
        • Özbek C
        • Schieffer H
        • Markwirth T.
        Long-term follow-up of a randomized study of primary stenting versus angioplasty in acute myocardial infarction.
        Am J Med. 2001; 110: 1-6
        • Siontis GCM
        • Stefanini GG
        • Mavridis D
        • Siontis KC
        • Alfonso F
        • Pérez-Vizcayno MJ
        • Byrne RA
        • Kastrati A
        • Meier B
        • Salanti G
        • Jüni P
        • Windecker S.
        Percutaneous coronary interventional strategies for treatment of in-stent restenosis: a network meta-analysis.
        Lancet. 2015; 386: 655-664
        • Theodoropoulos K
        • Mennuni MG
        • Dangas GD
        • Meelu OA
        • Bansilal S
        • Baber U
        • Sartori S
        • Kovacic JC
        • Moreno PR
        • Sharma SK
        • Mehran R
        • Kini AS.
        Resistant in-stent restenosis in the drug eluting stent era.
        Catheter Cardiovasc Interv. 2016; 88: 777-785
        • Megaly M
        • Glogoza M
        • Xenogiannis I
        • Vemmou E
        • Nikolakopoulos I
        • Omer M
        • Saad M
        • Willson L
        • Monyak DJ
        • Sullivan P
        • Pershad A
        • Chavez I
        • Mooney M
        • Traverse J
        • Wang Y
        • Garcia S
        • Poulose A
        • Burke MN
        • Brilakis ES.
        Coronary intravascular brachytherapy for recurrent coronary drug-eluting stent in-stent restenosis: a systematic review and meta-analysis.
        Cardiovasc Revasc Med. 2021; 23: 28-35
        • Jeger RV
        • Eccleshall S
        • Wan Ahmad WA
        • Ge J
        • Poerner TC
        • Shin ES
        • Alfonso F
        • Latib A
        • Ong PJ
        • Rissanen TT
        • Saucedo J
        • Scheller B
        • Kleber FX
        International DCB Consensus Group. Drug-coated balloons for coronary artery disease: third report of the international DCB consensus group.
        JACC Cardiovasc Interv. 2020; 13: 1391-1402
        • Yabushita H
        • Kawamoto H
        • Fujino Y
        • Tahara S
        • Horikoshi T
        • Tada M
        • Amano T
        • Onishi H
        • Nakajima A
        • Warisawa T
        • Watanabe Y
        • Yoshizaki T
        • Mitomo S
        • Sato T
        • Naganuma T
        • Ishiguro H
        • Kurita N
        • Nakamura S
        • Hozawa K
        • Nakamura S.
        Clinical outcomes of drug-eluting balloon for in-stent restenosis based on the number of metallic layers.
        Circ Cardiovasc Interv. 2018; 11e005935
        • Elgendy IY
        • Gad MM
        • Elgendy AY
        • Mahmoud A
        • Mahmoud AN
        • Cuesta J
        • Rivero F
        • Alfonso F
        Clinical and angiographic outcomes With drug-coated balloons for de novo coronary lesions: a meta-analysis of randomized clinical trials.
        J Am Heart Assoc. 2020; 9e016224
        • Scheller B
        • Rissanen TT
        • Farah A
        • Ohlow MA
        • Mangner N
        • Wöhrle J
        • Möbius-Winkler S
        • Weilenmann D
        • Leibundgut G
        • Cuculi F
        • Gilgen N
        • Coslovsky M
        • Mahfoud F
        • Jeger RV
        BASKET-SMALL 2 Investigators. Drug-coated balloon for small coronary artery disease in patients with and without high-bleeding risk in the BASKET-SMALL 2 trial.
        Circ Cardiovasc Interv. 2022; 15e011569
        • Cortese B
        • Di Palma G
        • Guimaraes MG
        • Piraino D
        • Orrego PS
        • Buccheri D
        • Rivero F
        • Perotto A
        • Zambelli G
        • Alfonso F.
        Drug-coated balloon Versus drug-eluting stent for small coronary vessel disease: PICCOLETO II Randomized Clinical Trial.
        JACC Cardiovasc Interv. 2020; 13: 2840-2849
        • Yeh RW
        • Bachinsky W
        • Stoler R
        • Bateman C
        • Tremmel JA
        • Abbott JD
        • Dohad S
        • Batchelor W
        • Underwood P
        • Allocco DJ
        • Kirtane AJ.
        Rationale and design of a randomized study comparing the agent drug coated balloon to plain old balloon angioplasty in patients with in-stent restenosis.
        Am Heart J. 2021; 241: 101-107