Authors' objectives:

The aim of this report was to summarise the available evidence on coronary transluminal angioplasty with coated stents.

Authors' results and conclusions: Many randomized, controlled clinical trials have been carried out to compare these stents against conventional ones. They report an average of 80% in restenosis risk reduction, although most of these studies report angiographic restenosis but not that which requires another revascularization due to symptoms. Besides, these trials treated patients with lower risk than what is seen in everyday practice. Although the results are promising, the existing evidence to evaluate their safety and efficacy is limited by a series of factors (few studies, lack of long term follow-up, clinical results reported in different ways, etc). In different economic analysis performed in other countries, it was reported that the use of coated stents is initially more expensive, but the reduction observed in new procedures makes the costs at one year similar for both strategies (conventional stents vs coated stents).

Authors' recommendations: It is important to have the results of new clinical trails, with longer follow-ups and analysis of different sub-groups with higher baseline risk of restenosis. It is difficult, at this stage, to make general recommendations for their use for coronary disease patients in our country. They could be recommended, preferably, for patients with high risk of intrastent restenosis, although this strategy has not yet been thoroughly evaluated in clinical trials. The use of coated stents can be recommended in the following cases: 1) De novo lesions of 15 to 30 mm in length and 2.5 to 3.5 mm in diameter with a 50 to 99% obstruction; 2) Angioplasty in diabetics y 3) De NOVO lesions of <15mm in length and 2.5 to 3.5 mm in diameter. There is not enough evidence yet to use these stents in a systematic fashion for focal intrastent restenosis. Their use is not advisable for lesions of >30 mm in length and 2.5 to 3.5 mm in diameter, total occlusions, non-protected main coronary artery lesions, venous graft lesions and diffuse intrastent restenosis.

Authors' methods: Economic evaluation

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)